Shopko Stores Operating Co. LLC

NPI #1609828136 in Logan, Utah

Provider Information

NPI Number
1609828136
Entity Type
Organization
Organization Name
Shopko Stores Operating Co. LLC
Primary Specialty
Eyewear Supplier
Enumeration Date
May 16, 2006
Last Updated
Jul 10, 2008

Practice Location

Address
1341 N MAIN ST
City
Logan
State
Utah
ZIP Code
84341-2221
Phone
(435) 753-0700

Authorized Official

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

Specialties & Taxonomy Codes

Specialty
Optometrist
Technician/Technologist - OpticianOptician
Eyewear Supplier

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