Shopko Optical 050

LBN: Shopko Stores Operating Co. Llc
Shopko Optical 050 is an health care organization with primary practice located at 616 W Johnson St , Fond Du Lac WI 54935-3134. 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) 921-8290, or through Bettiga, Michael J via phone (920) 429-4297.

Contact Information

Primary practice address
616 W Johnson St Fond Du Lac WI 54935-3134
Phone: (920) 921-8290
Fax:
Website:
Map and Directions
Authorized official contact:
Name: Bettiga, Michael J RPH
Phone: (920) 429-4297

Health care specialties

SpecialtyCodeLicense #State
Suppliers / Eyewear Supplier (Equipment, not the service) 332H00000X

Profile Details

NPI number 1013960723
LBN Legal business name Shopko Stores Operating Co. Llc
DBA Doing business as Shopko Optical 050
Authorized official Bettiga, Michael J RPH
Entity Organization
Organization subpart 1 No
Enumeration date May 17th, 2006
Last updated Feb 11th, 2008 - about 18 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1013960723 NPPES
Other 014050 VIP
Other 410985054-4050 VIP
Other 17654 VIP
Other 35560 VIP
Other CP2230-3 VIP
MEDICAID 38426900 VIP
Other 42597 VIP

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