Active NPI
Shoptikal LLC
Doing business as Shopko Optical 4073
- Eyewear Supplier
- Union Gap, WA
National Provider Identifier
1699331074
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Eyewear Supplier
- Legal business name
- SHOPTIKAL LLC
- Doing business as
- Shopko Optical 4073
- Practice address
- 2529 Main St Ste P6-a
Union Gap, WA 98903-1690 - Phone
- (509) 248-9833
- NPI assigned
- May 11, 2019
- 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 |
|---|---|---|---|---|
| Eyewear Supplier | 332H00000X | Primary | ||
| Optometrist | 152W00000X |
Addresses
Primary practice location
2529 Main St Ste P6-a
Union Gap, WA 98903-1690
Mailing address
PO Box 19060
Green Bay, WI 54307-9060
Other names 1
- Shopko Optical 4073
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190708001493 | WA | Part B Supplier - Clinic/Group Practice | 1456684471 |
Receives reassigned benefits from 5 practitioners 2 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Spokane, WA; Union Gap, WA; Wenatchee, WA |
Other NPIs on the same Medicare enrollment 2
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider Directory- Tax ID family
- Shoptikal LLC
Organizations with this tax ID in the same state 2
This tax ID family is large, so up to 24 of its organizations in the same state are linked here.
Locations
2529 Main St
Ste P6A
Union Gap, WA 98903
Phone (509) 248-9833
Practitioners & affiliated clinicians
Practitioners 2
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.
-
- Optometrist
- Pullman, WA
- NPI 1528010121
-
- Optometrist
- Stanwood, WA
- NPI 1780912170
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1557532800000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1732838400000",
"number": "1699331074",
"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": "2529 MAIN ST STE P6-A",
"city": "UNION GAP",
"state": "WA",
"postal_code": "989031690",
"telephone_number": "509-248-9833"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SHOPTIKAL LLC",
"organizational_subpart": "NO",
"enumeration_date": "2019-05-11",
"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": "332H00000X",
"taxonomy_group": "",
"desc": "Eyewear Supplier",
"state": null,
"license": null,
"primary": true
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Shopko Optical 4073",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Shopko Optical 4073",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Union Gap, WA
- Ronald Spencer Senn, DDS
- Justin Sang Seo, PHARMD
- SHC Medical Center Toppenish (Astria Health Center)
- Shopko Stores Operating Co LLC (ShopKo Pharmacy 073)
- Shopko Stores Operating Co. LLC (ShopKo Optical 073)
- Betty Simmons, CCC-SLP
- Melissa Sixberry, RN
- Keisha Smith
- Lloyd D Smith, RPH
- Robin K Spooner, SLP
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.