NPI 1053363010

Shopko Stores Operating Co. LLC

Organisation Eyewear Supplier Fort Atkinson, WI

Practice location

Address: 1425 Janesville Ave, Fort Atkinson, WI 53538-2705
Phone: (920) 563-2171

Authorised official

Name: Michael J Bettiga
Title: Sr. Vice President Health Services
Phone: (920) 429-4297

Registered specialties

Eyewear Supplier Primary

Suppliers Taxonomy 332H00000X

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Registry record

NPI: 1053363010
Entity type: Organization
NPI issued: 17 May 2006
Record last updated: 11 Feb 2008

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.