Shopko Optical 164

LBN: Shopko Stores Operating Co. Llc
Shopko Optical 164 is an health care organization with primary practice located at 255 John F Kennedy Rd , Dubuque IA 52002-5313. 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 (563) 583-5895, or through Bettiga, Michael J via phone (920) 429-4297.

Contact Information

Primary practice address
255 John F Kennedy Rd Dubuque IA 52002-5313
Phone: (563) 583-5895
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 1518910140
LBN Legal business name Shopko Stores Operating Co. Llc
DBA Doing business as Shopko Optical 164
Authorized official Bettiga, Michael J RPH
Entity Organization
Organization subpart 1 No
Enumeration date May 17th, 2006
Last updated Feb 11th, 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 1518910140 NPPES
Other 014164 VIP
Other 70091 VIP
Other 17711 VIP
Other 35437 VIP
MEDICAID 025-6347 VIP
Other OP1541 VIP

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