SHOPKO STORES OPERATING CO. LLC
NPI: 1013960723
· FOND DU LAC, WI 54935
· 332H00000X
$481.94
Total Medicaid Paid
Monthly Spending Trend
Yearly Breakdown
| Year | Claims | Total Paid |
|---|
| 2018 |
29 |
$481.94 |
Billing Codes
| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
|
15 |
12 |
$481.94 |
| V2020 |
Vision svcs frames purchases |
14 |
12 |
$0.00 |