Shopko Stores Operating,co.,llc

NPI #1265483168 in Oregon, Wisconsin

Provider Information

NPI Number: 1265483168
Entity Type: Organization
Organization Name: Shopko Stores Operating,co.,llc
Primary Specialty: Optometrist
Enumeration Date: May 15, 2006
Last Updated: Aug 22, 2020

Practice Location

Address: 6218 TRAIL RIDGE CT
City: Oregon
State: Wisconsin
ZIP Code: 53575-2534
Phone: (608) 222-9420

Authorized Official

Name: DR. RICHARD DEWEY OLSON, O.D.
Title: OPTOMOTRIST
Phone: (608) 222-9420

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Optometrist	152W00000X	Primary

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