Shopko Optical 504

LBN: Shopko Stores Operating Co Llc
Shopko Optical 504 is an health care organization with primary practice located at W3208 Van Roy Rd , Appleton WI 54915. 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 (920) 111-1111, or through Bettiga, Michael via phone (920) 429-4297.

Contact Information

Primary practice address
W3208 Van Roy Rd Appleton WI 54915
Phone: (920) 111-1111
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Bettiga, Michael RPH
Phone: (920) 429-4297

Health care specialties

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

Profile Details

NPI number 1114100518
LBN Legal business name Shopko Stores Operating Co Llc
DBA Doing business as Shopko Optical 504
Authorized official Bettiga, Michael RPH
Entity Organization
Organization subpart 1 No
Enumeration date Dec 10th, 2007
Last updated Jul 17th, 2008 - about 17 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 1114100518 NPPES
Other 1114100518 ANTHEM BCBS WI
MEDICAID 38461200 ANTHEM BCBS WI
Other 59715 ANTHEM BCBS WI
Other 60677 ANTHEM BCBS WI
Other 300133 ANTHEM BCBS WI

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