Shoptikal LLC
Organization Active NPI Eyewear Supplier · West Jordan, UT
NPI 1407412885 · NPPES record last updated Nov 29, 2024
Key facts
- NPI
- 1407412885
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Eyewear Supplier 332H00000X
- Legal business name
- SHOPTIKAL LLC
- Practice address
- 1520 W 9000 S Ste E
West Jordan, UT 84088-8001 - Phone
- (801) 561-7300
- NPI assigned
- May 11, 2019
- Organization subpart
- No
Authorized official
- Name
- Russell Steinhorst
- Title
- Evp & Cfo
- Phone
- (920) 429-7489
Other NPIs on the same Medicare enrollment 4
Other NPIs with the same Medicare PAC ID 11
Corporate family (same tax ID) 6
Practitioners 199
-
Carlyle Derek Swain, O.D.
-
Steven Charles Dewey, O.D.
-
Scott Roberts Haderlie, O.D.
-
Ben Philbert Cannon, O.D.
-
Michael Davis, O.D.
-
Karl Thomas Jepson, O.D.
-
Nicole L Amidon, O.D.
-
Bret A Ammeraal, O.D.
-
David J Anderson, O.D.
-
April Ann Austing, O.D.
-
Jenna Kay Backowski, O.D.
-
Michael Eric Banwart, O.D.
-
Megan Elise Barbot-Smith, O.D.
-
Nicholas Barlas, OD
-
Cole Barnhart, OD
-
Shanon S Bencker, OD
-
Timothy Donald Bevers, O.D.
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 Practice locations: Centerville, UT; West Valley City, UT; West Jordan, UT; Layton, UT; Logan, UT |
National Provider Directory
- Tax ID family
- Shoptikal LLC
Locations
1520 W 9000 S
Ste E
West Jordan, UT 84088
Phone (801) 561-7300
2843 S 5600 W
Ste 110
West Valley City, UT 84120
Phone (801) 967-6300
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | |||
| Eyewear Supplier | 332H00000X | Yes |
Addresses
Primary practice location
1520 W 9000 S Ste E
West Jordan, UT 84088-8001
Mailing address
PO Box 19060
Green Bay, WI 54307-9060
Other names
- Shopko Optical 4084
Other providers in West Jordan, 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.