Active NPI
Shoptikal LLC
Doing business as Shopko Optical 4240
- Eyewear Supplier
- Centerville, UT
National Provider Identifier
1215528138
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Eyewear Supplier
- Legal business name
- SHOPTIKAL LLC
- Doing business as
- Shopko Optical 4240
- Practice address
- 331 W Parrish LN Ste 104
Centerville, UT 84014-1853 - Phone
- (385) 330-2211
- NPI assigned
- Feb 2, 2021
- Last updated
- Nov 29, 2024
- Organization subpart
- No
NPPES NPI Registry
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) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | |||
| Eyewear Supplier | 332H00000X | Primary |
Addresses
Primary practice location
331 W Parrish LN Ste 104
Centerville, UT 84014-1853
Mailing address
PO Box 19060
Green Bay, WI 54307-9060
Phone (920) 429-7842
Other names 1
- Shopko Optical 4240
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in UT
Enrollment records 1
| 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 |
Other NPIs on the same Medicare enrollment 4
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
-
dba Shopko Optical 4097
- Eyewear Supplier
- West Valley City, UT
- NPI 1043876428
O20190627000568
-
dba Shopko Optical 4084
- Eyewear Supplier
- West Jordan, UT
- NPI 1407412885
O20190627000568
National Provider Directory
National Provider Directory- Tax ID family
- Shoptikal LLC
Organizations with this tax ID in the same state 6
This tax ID family is large, so up to 24 of its organizations in the same state are linked here.
Locations
331 W Parrish Ln
Ste 104
Centerville, UT 84014
Phone (385) 300-2211
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1612224000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1732838400000",
"number": "1215528138",
"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": "331 W PARRISH LN STE 104",
"city": "CENTERVILLE",
"state": "UT",
"postal_code": "840141853",
"telephone_number": "385-330-2211"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SHOPTIKAL LLC",
"organizational_subpart": "NO",
"enumeration_date": "2021-02-02",
"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 4240",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Shopko Optical 4240",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Centerville, UT
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.