Shopko Optical 058
LBN: Shopko Stores Operating Co. Llc
Shopko Optical 058 is an health care organization with primary practice located at 1755 N Humiston Ave , Worthington MN 56187-1757. 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 (507) 372-7811, or through Bettiga, Michael J via phone (920) 429-4297.
Contact Information
Primary practice address
1755 N Humiston Ave
Worthington MN 56187-1757
Phone: (507) 372-7811
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Suppliers / Eyewear Supplier (Equipment, not the service) | 332H00000X |
Profile Details
| NPI number | 1871545996 |
|---|---|
| LBN Legal business name | Shopko Stores Operating Co. Llc |
| DBA Doing business as | Shopko Optical 058 |
| Authorized official | Bettiga, Michael J RPH |
| Entity | Organization |
| Organization subpart 1 | No |
| Enumeration date | May 17th, 2006 |
| Last updated | Apr 15th, 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1871545996 | NPPES |
| Other | 17829 | MEDICARE | |
| Other | 3C194SH | MEDICARE | |
| Other | 20019120528 | MEDICARE | |
| Other | 42492 | MEDICARE | |
| Other | 213121-19 | MEDICARE | |
| Other | 35487 | MEDICARE | |
| Other | 014058 | MEDICARE | |
| Other | 33300 | MEDICARE |
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