NPI | 1750334348 |
---|---|
Doing Business As | SHOPKO OPTICAL 112 |
Entity Type | Organization |
Authorized Contact | MICHAEL J BETTIGA Sr. Vice President Health Services 920-429-4297 |
Organization Subpart ? | No |
Primary Taxonomy | 332H00000X Eyewear Supplier (Equipment, not the service) |
Additional Taxonomies | 156FX1800X Technician/Technologist, Optician |
152W00000X Optometrist | |
Enumeration Date | 2006-05-18 |
Last Update Date | 2008-04-24 |