institution
Shopko Stores Operating Co. Llc
Eyewear Supplier in Beaver Dam, Wisconsin
NPI 1396797411

Shopko Stores Operating Co. Llc is a Eyewear Supplier based in Beaver Dam, WI. Shopko Stores Operating Co. Llc practices in Beaver Dam, WI. The NPI Number for Shopko Stores Operating Co. Llc is 1396797411 and holds a License No. (Wisconsin).

The current practice location address for Shopko Stores Operating Co. Llc is 822 Park Ave, Beaver Dam, WI and can be reached out via phone at 920-887-3791.

Location: 822 Park Ave, Beaver Dam, WI, 53916-2266
institution
Provider Profile Details
NPI Number
1396797411
Provider Name
Shopko Stores Operating Co. Llc
Credential
Provider Entity Type
Organization
Address
822 Park Ave, Beaver Dam, WI, 53916-2266
Phone Number
920-887-3791
Fax Number
Provider Enumeration Date
05/17/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
410985054-4014 01 NVA
014014 01 VIP
17641 01 MEDICARE
42590 01 DAVIS
CP2230-61 01 EYEMED
38422300 05 WI
institution
Provider Business Practice Location Address Details
Address
822 Park Ave
City
State
Zip
53916-2266
Phone Number
920-887-3791
Fax Number
person
Provider Business Mailing Address Details
Address
822 Park Ave
City
State
Zip
53916-2266
Phone Number
920-887-3791
Fax Number
person
Provider's Taxonomy Details 1
Type
Suppliers
Classification
Eyewear Supplier
Speciality
-
Taxonomy
License No.
()
Definition
An organization that provides spectacles, contact lenses, and other vision enhancement devices prescribed by an optometrist or ophthalmologist.
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