Shopko Stores Operating Co. LLC

NPI #1982656096 in Boise, Idaho

Provider Information

NPI Number
1982656096
Entity Type
Organization
Organization Name
Shopko Stores Operating Co. LLC
Primary Specialty
Eyewear Supplier
Enumeration Date
May 17, 2006
Last Updated
Aug 3, 2009

Practice Location

Address
8105 FAIRVIEW AVE
City
Boise
State
Idaho
ZIP Code
83704-8486
Phone
(208) 323-9303

Authorized Official

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

Specialties & Taxonomy Codes

Specialty
Technician/Technologist - OpticianOptician
Eyewear Supplier

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