NPIMap

Organization Active NPI

Shoptikal LLC

Doing business as Shopko Optical 4177

  • Eyewear Supplier
  • Green Bay, WI
National Provider Identifier
1194381509
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 4177
Practice address
2314 Lineville Rd Ste 104
Green Bay, WI 54313-8860
Phone
(920) 434-5845
NPI assigned
May 13, 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
Russ Steinhorst
Title
Evp & Cfo
Phone
(920) 429-7842

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X
Eyewear Supplier 332H00000X Primary

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 1

  • Shopko Optical 4177 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 24

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

View all 24

Locations

N6663 Rolling Meadows Dr
Ste I
Fond du Lac, WI 54937
Phone (920) 921-8290

1154 Westowne Dr
Neenah, WI 54956
Phone (920) 751-0275

1056 E Green Bay St
Ste 500
Shawano, WI 54166
Phone (715) 990-2054

2314 Lineville Rd
Suamico, WI 54313

2314 Lineville Rd
Ste 104
Suamico, WI 54313
Phone (920) 434-5845

Practitioners & affiliated clinicians

Practitioners 15

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.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1557705600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732838400000",
    "number": "1194381509",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "P.O. BOX 19060",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "54307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2314 LINEVILLE RD STE 104",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543138860",
            "telephone_number": "920-434-5845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOPTIKAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-13",
        "last_updated": "2024-11-29",
        "certification_date": "2024-11-29",
        "status": "A",
        "authorized_official_last_name": "STEINHORST",
        "authorized_official_first_name": "RUSS",
        "authorized_official_title_or_position": "EVP & CFO",
        "authorized_official_telephone_number": "920-429-7842"
    },
    "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 4177",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Green Bay, 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.