Active NPI
Shoptikal LLC
Doing business as Shopko Optical 4247
- Eyewear Supplier
- Stoughton, WI
National Provider Identifier
1083288260
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Eyewear Supplier
- Legal business name
- SHOPTIKAL LLC
- Doing business as
- Shopko Optical 4247
- Practice address
- 2480 State Road 138 Ste 200
Stoughton, WI 53589-3702 - Phone
- (608) 889-1047
- NPI assigned
- May 13, 2021
- Last updated
- Nov 29, 2024
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Russell Steinhorst
- Title
- Evp & Cfo
- Phone
- (920) 429-7489
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Eyewear Supplier | 332H00000X | Primary | ||
| Optometrist | 152W00000X |
Addresses
Primary practice location
2480 State Road 138 Ste 200
Stoughton, WI 53589-3702
Mailing address
PO Box 19060
Green Bay, WI 54307-9060
Phone (920) 429-7842
Other names 1
- Shopko Optical 4247
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190606001553 | WI | Part B Supplier - Clinic/Group Practice | 1456684471 |
Receives reassigned benefits from 185 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
National Provider Directory- Tax ID family
- Shoptikal LLC
Organizations with this tax ID in the same state 17
This tax ID family is large, so up to 24 of its organizations in the same state are linked here.
Locations
2480 State Road 138
Stoughton, WI 53589
631 Hometown Cir
Ste 106
Verona, WI 53593
Phone (608) 653-6218
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Optometrist
- Honolulu, HI
- NPI 1609842186
-
- Optometrist
- Layfayette, IL
- NPI 1578998936
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1620864000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1732838400000",
"number": "1083288260",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 19060",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543079060",
"telephone_number": "920-429-7842"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2480 STATE ROAD 138 STE 200",
"city": "STOUGHTON",
"state": "WI",
"postal_code": "535893702",
"telephone_number": "608-889-1047"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SHOPTIKAL LLC",
"organizational_subpart": "NO",
"enumeration_date": "2021-05-13",
"last_updated": "2024-11-29",
"certification_date": "2024-11-29",
"status": "A",
"authorized_official_last_name": "STEINHORST",
"authorized_official_first_name": "RUSSELL",
"authorized_official_title_or_position": "EVP & CFO",
"authorized_official_telephone_number": "920-429-7489"
},
"taxonomies": [
{
"code": "332H00000X",
"taxonomy_group": "",
"desc": "Eyewear Supplier",
"state": null,
"license": null,
"primary": true
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Shopko Optical 4247",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Shopko Optical 4247",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Stoughton, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.