Shopko Optical 177

LBN: Shopko Stores Operating Co Llc
Shopko Optical 177 is an health care organization with primary practice located at 2320 Lineville Rd , Green Bay WI 54313-8836. 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) 434-5845, or through Bettiga, Michael via phone (920) 429-4297.

Contact Information

Primary practice address
2320 Lineville Rd Green Bay WI 54313-8836
Phone: (920) 434-5845
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 1942483342
LBN Legal business name Shopko Stores Operating Co Llc
DBA Doing business as Shopko Optical 177
Authorized official Bettiga, Michael RPH
Entity Organization
Organization subpart 1 No
Enumeration date Dec 10th, 2007
Last updated Apr 20th, 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.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1942483342 NPPES
Other 47608 AVESIS
Other 1952356644 AVESIS
MEDICAID 38461000 AVESIS
Other 146151 AVESIS
Other 1952356644 AVESIS
Other 125950 AVESIS
Other 58936 AVESIS
Other DF0804 AVESIS

Popular Providers