Shopko Stores Operating Co LLC

NPI #1427547082 in Mequon, Wisconsin

Provider Information

NPI Number: 1427547082
Entity Type: Organization
Organization Name: Shopko Stores Operating Co LLC
Primary Specialty: Eyewear Supplier
Enumeration Date: May 8, 2018
Last Updated: Jul 25, 2018

Practice Location

Address: 10996 N PORT WASHINGTON RD
City: Mequon
State: Wisconsin
ZIP Code: 53092
Phone: (262) 240-9870

Authorized Official

Name: DILIP SEDANI
Title: VP
Phone: (920) 429-7688

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Eyewear Supplier	332H00000X	Primary

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