| NPI | 1679139042 |
|---|---|
| Doing Business As | SHOPKO OPTICAL 4047 |
| Entity Type | Organization |
| Authorized Contact | JAMES EISEN CEO 920-429-7549 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Equipment, not the service) |
| Enumeration Date | 2019-05-11 |
| Last Update Date | 2019-09-04 |