Shopko Stores Operating Co. LLC
NPI #1952354540 in Idaho Falls, Idaho
Provider Information
- NPI Number
- 1952354540
- 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
- 800 E 17TH ST
- City
- Idaho Falls
- State
- Idaho
- ZIP Code
- 83404-6151
- Phone
- (208) 522-3795
Authorized Official
- Name
- MICHAEL J BETTIGA, RPH
- Title
- SR. VICE PRESIDENT HEALTH SERVICES
- Phone
- (920) 429-4297
Specialties & Taxonomy Codes
| Specialty |
|---|
| Technician/Technologist - Optician — Optician |
| Eyewear Supplier |
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