Shopko Stores Operating Co. LLC

NPI #1164475752 in Nampa, Idaho

Provider Information

NPI Number: 1164475752
Entity Type: Organization
Organization Name: Shopko Stores Operating Co. LLC
Primary Specialty: Eyewear Supplier
Enumeration Date: May 18, 2006
Last Updated: Aug 3, 2009

Practice Location

Address: 2100 CALDWELL BLVD
City: Nampa
State: Idaho
ZIP Code: 83651-1510
Phone: (208) 466-6895

Authorized Official

Name: MICHAEL J BETTIGA, RPH
Title: SR. VICE PRESIDENT HEALTH SERVICES
Phone: (920) 429-4297

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Technician/Technologist - Optician — Optician	156FX1800X
Eyewear Supplier	332H00000X	Primary

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