Shoptikal LLC
Organization Active NPI Eyewear Supplier · Grand Chute, WI
NPI 1669013256 · NPPES record last updated Nov 29, 2024
Key facts
- NPI
- 1669013256
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Eyewear Supplier 332H00000X
- Legal business name
- SHOPTIKAL LLC
- Practice address
- 123 N Mall Dr
Grand Chute, WI 54913-8531 - Phone
- (920) 429-7842
- NPI assigned
- Oct 4, 2019
- Organization subpart
- No
Authorized official
- Name
- Russell Steinhorst
- Title
- Evp & Cfo
- Phone
- (920) 429-7489
Corporate family (same tax ID) 24
Practitioners 3
-
Paul K Thompson, O.D.
-
Christine Luzuriaga, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
- Tax ID family
- Shoptikal LLC
Locations
123 N Mall Dr
Grand Chute, WI 54913
Phone (920) 429-7842
2185 Lincoln St
Rhinelander, WI 54501
Phone (715) 362-4800
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | |||
| Eyewear Supplier | 332H00000X | Yes |
Addresses
Primary practice location
123 N Mall Dr
Grand Chute, WI 54913-8531
Mailing address
PO Box 19060
Green Bay, WI 54307-9060
Other names
- Shopko Optical 4220
Other providers in Grand Chute, WI
- Mary Kirchner
- Susan C. Kruzel
- Meijer Stores Limited Partnership
- Roundys Supermarkets Inc
- Abigail Schreiber
- St Vincent Hospital-Hospital Sisters-Third Order of St Francis
- Town of Grand Chute
- Hannah R Tumilty
- Walgreen Co
- Tonya Janelle Wilderman
All providers in Grand Chute, WI · Eyewear Supplier in Wisconsin
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.