Steven Ticknor, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

3810-35 Issued in WI

Practice address

3621 Market LN
Kenosha, WI 53144-1553

Phone

(262) 658-8119

Fax

(262) 658-8261

NPI assigned

May 16, 2022

Last updated

Sep 4, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WI, IL2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Specialty

Optometry

Education

Illinois College of Optometry at Chicago, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Dr Charlotte F Nielsen PCGroup PAC ID 0143345447, 2 clinicians

Shoptikal LLCGroup PAC ID 1456684471, 192 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Shoptikal LLC

  dba Shopko Optical 4002

  • Eyewear Supplier
  • Green Bay, WI
  • NPI 1659937159

  Optometrist

  Medicare reassignment Care Compare group NPD
• Dr. Charlotte F. Nielsen, P.C.

  • Optometrist
  • Grayslake, IL
  • NPI 1033303169
  Medicare reassignment Care Compare group
• Shoptikal LLC

  dba Shopko Optical 4119

  • Eyewear Supplier
  • Dixon, IL
  • NPI 1699331082

  Optometrist

  Medicare reassignment NPD
• Shoptikal LLC

  dba Shopko Optical 4171

  • Eyewear Supplier
  • Plover, WI
  • NPI 1114583507

  Optometrist

  NPD
• Shoptikal LLC

  dba Fielmann Vision Care 4313

  • Eyewear Supplier
  • Rockford, IL
  • NPI 1467311142

  Optometrist

  NPD
• Shoptikal LLC

  dba Shopko Optical 4223

  • Eyewear Supplier
  • Elgin, IL
  • NPI 1588279566

  Optometrist

  NPD
• Shoptikal LLC

  dba Shopko Optical 4066

  • Eyewear Supplier
  • Spokane, WA
  • NPI 1154987535

  Optometrist

  NPD (past)

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

{
    "created_epoch": "1652659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725408000000",
    "number": "1174260715",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "568 WOODCREST DR",
            "city": "MUNDELEIN",
            "state": "IL",
            "postal_code": "600601525"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3621 MARKET LN",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531441553",
            "telephone_number": "262-658-8119",
            "fax_number": "262-658-8261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TICKNOR",
        "first_name": "STEVEN",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-05-16",
        "last_updated": "2024-09-04",
        "certification_date": "2024-09-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WI",
            "license": "3810-35",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dean Tiboris, DMD
• Kathryn A Tigue
• Tina Marie Tihen, PHYSICAL THERAPIST A
• Timemen Health Care LLC
• Maebel Y Tinoko
• Mark R Tisdale, PTA

• Optometrist in Kenosha, WI
• Providers in Kenosha, WI by specialty
• Optometrist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.