Shoptikal LLC
Organization Active NPI Eyewear Supplier · Green Bay, WI
NPI 1194381509 · NPPES record last updated Nov 29, 2024
Key facts
- NPI
- 1194381509
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Eyewear Supplier 332H00000X
- Legal business name
- SHOPTIKAL LLC
- Practice address
- 2314 Lineville Rd Ste 104
Green Bay, WI 54313-8860 - Phone
- (920) 434-5845
- NPI assigned
- May 13, 2019
- Organization subpart
- No
Authorized official
- Name
- Russ Steinhorst
- Title
- Evp & Cfo
- Phone
- (920) 429-7842
Corporate family (same tax ID) 24
Practitioners 15
-
Kyle J Klika, O.D.
-
Courtney Lee O'Keefe, O.D.
-
Navjit Kaur Sanghera, O.D.
-
Cole Barnhart, OD
-
Jamie Lynn Ertl, OD
-
Michelle Marie Mueller, O.D.
-
Nicholas Roovers, OD
-
Krista Kay King, O.D.
-
Blaze Sammon, OD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| 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
- Tax ID family
- Shoptikal LLC
Locations
1810 Jackson St
Oshkosh, WI 54901
Phone (920) 385-1262
1212 S Koeller St
Oshkosh, WI 54902
Phone (920) 426-5730
2314 Lineville Rd
Suamico, WI 54313
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | |||
| Eyewear Supplier | 332H00000X | Yes |
Addresses
Primary practice location
2314 Lineville Rd Ste 104
Green Bay, WI 54313-8860
Mailing address
P.O. Box 19060
Green Bay, WI 54307
Other names
- Shopko Optical 4177
Other providers in Green Bay, WI
- Shopko Stores Operating Co. LLC
- Shopko Stores Operating Co. LLC
- Shopko Stores Operating Co. LLC
- Shopko Stores Operating Company
- Shopko Stores, Inc.
- Shoptikal LLC
- Shoptikal LLC
- Shoptikal LLC
- Shoptikal LLC
- John Fredrick Shrake
All providers in Green Bay, WI · Eyewear Supplier in Wisconsin
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.