NPIMap

Organization Active NPI

Shoptikal LLC

Doing business as Shopko Optical 4061

  • Eyewear Supplier
  • Saint Cloud, MN
National Provider Identifier
1568028710
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 4061
Practice address
501 Highway 10 S
Saint Cloud, MN 56304-1250
Phone
(320) 253-4695
NPI assigned
May 14, 2019
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
Russell Steinhorst
Title
Evp & Cfo
Phone
(920) 429-7489

Specialties & licenses 2

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

Addresses

Primary practice location

501 Highway 10 S
Saint Cloud, MN 56304-1250

Mailing address

PO Box 19060
Green Bay, WI 54307-9060

Other names 1

  • Shopko Optical 4061 Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20190611002309 MN Part B Supplier - Clinic/Group Practice 1456684471 Receives reassigned benefits from 39 practitioners
33 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Marshall, MN; Mountain Iron, MN; Montevideo, MN; Morris, MN; Oak Park Heights, MN; Owatonna, MN; Red Wing, MN; Rochester, MN…

Other NPIs on the same Medicare enrollment 33

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 33

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1557792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732838400000",
    "number": "1568028710",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 HIGHWAY 10 S",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563041250",
            "telephone_number": "320-253-4695"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOPTIKAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-14",
        "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 4061",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Shopko Optical 4061",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Saint Cloud, MN

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.