NPI 1073565180

Shopko Stores Operating Co. LLC

Organisation Eyewear Supplier Peoria, IL

Practice location

Address: 2323 W Pioneer Pkwy, Peoria, IL 61615-1833
Phone: (309) 691-4815

Authorised official

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

Registered specialties

Eyewear Supplier Primary

Suppliers Taxonomy 332H00000X

Other Eyewear Supplier providers in Illinois →

Registry record

NPI: 1073565180
Entity type: Organization
NPI issued: 17 May 2006
Record last updated: 28 Sep 2007

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.