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Shopko Stores Operating Co. Llc
Eyewear Supplier in East Peoria, Illinois
NPI 1619929015

Shopko Stores Operating Co. Llc is a Eyewear Supplier based in East Peoria, IL. Shopko Stores Operating Co. Llc practices in East Peoria, IL. The NPI Number for Shopko Stores Operating Co. Llc is 1619929015 and holds a License No. (Illinois).

The current practice location address for Shopko Stores Operating Co. Llc is 105 N Main St, East Peoria, IL and can be reached out via phone at 309-694-6470.

Location: 105 N Main St, East Peoria, IL, 61611-2543
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
institution
Provider Profile Details
NPI Number
1619929015
Provider Name
Shopko Stores Operating Co. Llc
Credential
Provider Entity Type
Organization
Address
105 N Main St, East Peoria, IL, 61611-2543
Phone Number
309-694-6470
Fax Number
Provider Enumeration Date
05/16/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
17690 01 MEDICARE
42574 01 DAVIS
CP2230-14 01 EYEMED
014173 01 VIP
institution
Provider Business Practice Location Address Details
Address
105 N Main St
City
East Peoria
State
Illinois
Zip
61611-2543
Phone Number
309-694-6470
Fax Number
person
Provider Business Mailing Address Details
Address
105 N Main St
City
East Peoria
State
Illinois
Zip
61611-2543
Phone Number
309-694-6470
Fax Number
person
Provider's Taxonomy Details 1
Type
Suppliers
Classification
Eyewear Supplier
Speciality
-
Taxonomy
332H00000X
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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