Shoptikal LLC
Organization Active NPI Eyewear Supplier · Logan, UT
NPI 1194334979 · NPPES record last updated Nov 29, 2024
Key facts
- NPI
- 1194334979
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Eyewear Supplier 332H00000X
- Legal business name
- SHOPTIKAL LLC
- Practice address
- 1205 N Main St
Logan, UT 84341-2219 - Phone
- (435) 554-1660
- NPI assigned
- Jul 28, 2020
- Organization subpart
- No
Authorized official
- Name
- Russell Steinhorst
- Title
- Evp & Cfo
- Phone
- (920) 429-7489
Other NPIs on the same Medicare enrollment 4
Corporate family (same tax ID) 6
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190627000568 | UT | Part B Supplier - Clinic/Group Practice | 1456684471 |
Receives reassigned benefits from 8 practitioners 4 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Centerville, UT; West Valley City, UT; West Jordan, UT; Layton, UT; Logan, UT |
National Provider Directory
- Tax ID family
- Shoptikal LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | |||
| Eyewear Supplier | 332H00000X | Yes |
Addresses
Primary practice location
1205 N Main St
Logan, UT 84341-2219
Mailing address
PO Box 19060
Green Bay, WI 54307-9060
Phone (920) 429-7842
Other names
- Shopko Optical 4233
NPI Registry JSON
{
"created_epoch": "1595894400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1732838400000",
"number": "1194334979",
"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": "1205 N MAIN ST",
"city": "LOGAN",
"state": "UT",
"postal_code": "843412219",
"telephone_number": "435-554-1660"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SHOPTIKAL LLC",
"organizational_subpart": "NO",
"enumeration_date": "2020-07-28",
"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": "152W00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Optometrist",
"state": null,
"license": null,
"primary": false
},
{
"code": "332H00000X",
"taxonomy_group": "",
"desc": "Eyewear Supplier",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Shopko Optical 4233",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Shopko Optical 4233",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Logan, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 29, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.