| NPI | 1942793179 |
|---|---|
| Doing Business As | SHOPKO EYECARE CENTER 4505 |
| Entity Type | Organization |
| Authorized Contact | DILIP SEDANI VP 920-429-7688 |
| Organization Subpart ? | No |
| Primary Taxonomy | 332H00000X Eyewear Supplier (Equipment, not the service) |
| Enumeration Date | 2018-06-12 |
| Last Update Date | 2018-06-12 |