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General NPI Number Information
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NPI Number | 1346292745
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Entity Type | Organization
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Legal Business Name | SHOPKO STORES OPERATING CO. LLC
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 06/08/2018
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Provider Practice Location Address
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Address Line | 7401 MINERAL POINT RD
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City | MADISON
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State | WI
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Zip | 53717
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Country | US
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Telephone | 608-833-5700
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Fax |
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Provider Business Mailing Address
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Address Line | 7401 MINERAL POINT RD
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City | MADISON
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State | WI
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Zip | 53717-1703
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Country | US
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Telephone | 608-833-5700
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Fax |
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Authorized Official
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Title or Position | E
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Name | DILIP SEDANI
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Credential |
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Telephone | 920-429-7688
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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