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General NPI Number Information
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NPI Number | 1558314328
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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 | 05/19/2006
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Last Update Date | 09/02/2018
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Provider Practice Location Address
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Address Line | 2201 ZEIER RD
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City | MADISON
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State | WI
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Zip | 53704
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Country | US
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Telephone | 608-246-2161
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Fax |
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Provider Business Mailing Address
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Address Line | 2201 ZEIER RD
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City | MADISON
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State | WI
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Zip | 53704-7415
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Country | US
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Telephone | 608-246-2161
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Fax |
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Authorized Official
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Title or Position | VP
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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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