Shopko Optical 174

LBN: Shopko Stores Operating Co. Llc
Shopko Optical 174 is an health care organization with primary practice located at 2323 W Pioneer Pkwy , Peoria IL 61615-1833. The organization recently has only one registered license in Suppliers / Eyewear Supplier (Equipment, not the service), which is considered as the primary health care specialty. Shopko Stores Operating Co. Llc can be contacted via phone (309) 691-4815, or through Bettiga, Michael J via phone (920) 429-4297.

Contact Information

Primary practice address
2323 W Pioneer Pkwy Peoria IL 61615-1833
Phone: (309) 691-4815
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Bettiga, Michael J RPH
Phone: (920) 429-4297

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Eyewear Supplier (Equipment, not the service) 332H00000X

Profile Details

NPI number 1073565180
LBN Legal business name Shopko Stores Operating Co. Llc
DBA Doing business as Shopko Optical 174
Authorized official Bettiga, Michael J RPH
Entity Organization
Organization subpart 1 No
Enumeration date May 17th, 2006
Last updated Sep 28th, 2007 - about 18 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1073565180 NPPES
Other 17691 MEDICARE
Other 35458 MEDICARE
Other 014174 MEDICARE
Other CP230-16 MEDICARE
Other 42575 MEDICARE

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