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Shoptikal LLC

Organization Active NPI Eyewear Supplier · Green Bay, WI

NPI 1659937159 · NPPES record last updated Nov 29, 2024

Key facts

NPI
1659937159
Entity type
Organization (NPI type 2)
Primary specialty
Eyewear Supplier 332H00000X
Legal business name
SHOPTIKAL LLC
Practice address
2621 S Oneida St Ste 104
Green Bay, WI 54304-5793
Phone
(920) 499-3511
NPI assigned
May 10, 2019
Organization subpart
No

Authorized official

Name
Russell Steinhorst
Title
Evp & Cfo
Phone
(920) 429-7489

Other NPIs with the same Medicare PAC ID 11

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Corporate family (same tax ID) 24

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners 284

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 284

Medicare participation

Medicare fee-for-service enrollment
Enrolled in WI

Medicare enrollment records

Enrollment IDStateProvider typePAC IDDetails
O20190606001553 WI Part B Supplier - Clinic/Group Practice 1456684471 Receives reassigned benefits from 185 practitioners

National Provider Directory

Tax ID family
Shoptikal LLC (168 organizations share this tax ID)

Locations

2621 S Oneida St
Green Bay, WI 54304
Phone (920) 499-3511

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist
Group: 193400000X SINGLE SPECIALTY GROUP		 152W00000X
Eyewear Supplier 332H00000X Yes

Addresses

Primary practice location

2621 S Oneida St Ste 104
Green Bay, WI 54304-5793

Mailing address

PO Box 19060
Green Bay, WI 54307-9060

Other names

  • Shopko Optical 4002 Doing business as

Other providers in Green Bay, WI

All providers in Green Bay, WI · Eyewear Supplier in Wisconsin

Sources for this page

Verify at the official NPI Registry.