NPI 1821040973
Shopko Stores Operating Co. LLC
Practice location
- Address
- 1649 Poleline Rd E, Twin Falls, ID 83301-3592
- Phone
- (208) 734-3908
Authorised official
- Name
- Michael J Bettiga
- Title
- Sr. Vice President Health Services
- Phone
- (920) 429-4297
Registered specialties (2)
Eyewear Supplier
Primary
Registry record
- NPI
- 1821040973
- Entity type
- Organization
- NPI issued
- 17 May 2006
- Record last updated
- 3 Aug 2009
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.