SHOPKO STORES OPERATING CO. LLC; NPI #1639121601

Contact Information

SHOPKO STORES OPERATING CO. LLC

1850 E MADISON AVE
MANKATO, MN 56001-5448

Phone: 507-387-6517
Fax:
Website:

	Specialty	Taxonomy Code	Specialty Code	Provider Type
	Eyewear Supplier	332H00000X	87	All Other Suppliers

Indicates primary specialty

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NPI Profile & details for SHOPKO STORES OPERATING CO. LLC

NPI Number 1639121601

LBN Legal business name SHOPKO STORES OPERATING CO. LLC

Authorized official MICHAEL BETTIGA - (SR. VICE PRESIDENT HEALTH SERVICES)

Entity Organization

Organization subpart ¹ No

Enumeration date 05/17/2006

Last updated 04/15/2008 - About 18 years ago

Identifiers

Other	35694	AVESIS
Other	42607	DAVIS
Other	213121-14	EYEMED
Other	17822	MEDICARE
Other	41619SH	MN MA FIRST PLAN OF MN
Other	2100546	MN MA MEDICA CHOICE CARE
Other	20019120525	MN MA PRIMEWEST HEALTH
Other	410985054-4021	NATIONAL VISION ADMIN.
Other	014021	VIP

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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SHOPKO STORES OPERATING CO. LLC

Contact Information

Specialty

Eyewear Supplier

NPI Profile & details for SHOPKO STORES OPERATING CO. LLC

Reviews for SHOPKO STORES OPERATING CO. LLC