Shopko Stores Operating Co. LLC

NPI #1982656419 in Provo, Utah

Provider Information

NPI Number: 1982656419
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: 2266 N UNIVERSITY PKWY
City: Provo
State: Utah
ZIP Code: 84604-1510
Phone: (801) 373-1300

Authorized Official

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

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Optometrist	152W00000X
Technician/Technologist - Optician — Optician	156FX1800X
Eyewear Supplier	332H00000X	Primary

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