NPIMap

Organization Active NPI

Shoptikal LLC

Doing business as Shopko Optical 4014

  • Eyewear Supplier
  • Beaver Dam, WI
National Provider Identifier
1154987576
Registry record updated Nov 29, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
Legal business name
SHOPTIKAL LLC
Doing business as
Shopko Optical 4014
Practice address
820 Park Ave Ste I
Beaver Dam, WI 53916-2265
Phone
(920) 887-3791
NPI assigned
May 10, 2019
Last updated
Nov 29, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 29, 2024

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)CodeLicenseStatePrimary
Eyewear Supplier 332H00000X NU Primary
Optometrist 152W00000X NU

Addresses

Primary practice location

820 Park Ave Ste I
Beaver Dam, WI 53916-2265

Mailing address

PO Box 19060
Green Bay, WI 54307-9060

Other names 1

  • Shopko Optical 4014 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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 LLC169 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 23

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 23

Locations

820 Park Ave
Beaver Dam, WI 53916

Practitioners & affiliated clinicians

Practitioners 5

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1557446400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732838400000",
    "number": "1154987576",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "820 PARK AVE STE I",
            "city": "BEAVER DAM",
            "state": "WI",
            "postal_code": "539162265",
            "telephone_number": "920-887-3791"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOPTIKAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-10",
        "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": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Shopko Optical 4014",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Shopko Optical 4014",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Beaver Dam, 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.

Verify at the official NPI Registry.