Shopko Optical 015

LBN: Shopko Stores Operating Co. Llc
Shopko Optical 015 is an health care organization with primary practice located at 1000 W Northland Ave , Appleton WI 54914-1419. 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) 731-4511, or through Bettiga, Michael J via phone (920) 429-4297.

Contact Information

Primary practice address
1000 W Northland Ave Appleton WI 54914-1419
Phone: (920) 731-4511
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 1295787315
LBN Legal business name Shopko Stores Operating Co. Llc
DBA Doing business as Shopko Optical 015
Authorized official Bettiga, Michael J RPH
Entity Organization
Organization subpart 1 No
Enumeration date May 17th, 2006
Last updated Feb 11th, 2008 - about 16 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 1295787315 NPPES
Other 17667 MEDICARE
MEDICAID 38404500 MEDICARE
Other 42594 MEDICARE
Other 014015 MEDICARE
Other 410985054-4015 MEDICARE
Other CP2230-94 MEDICARE

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