Shoptikal LLC
Organization Active NPI Eyewear Supplier · Jacksonville, IL
NPI 1760048151 · NPPES record last updated Nov 29, 2024
Key facts
- NPI
- 1760048151
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Eyewear Supplier 332H00000X
- Legal business name
- SHOPTIKAL LLC
- Practice address
- 1705 W Morton Ave
Jacksonville, IL 62650-2719 - Phone
- (217) 245-6070
- NPI assigned
- May 12, 2019
- Organization subpart
- No
Authorized official
- Name
- Russell Steinhorst
- Title
- Evp & Cfo
- Phone
- (920) 429-7489
Other NPIs on the same Medicare enrollment 17
Practitioners 3
-
David J Anderson, O.D.
-
Winona Marie Van Houten, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190611001268 | IL | Part B Supplier - Clinic/Group Practice | 1456684471 |
Receives reassigned benefits from 22 practitioners 17 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Lakemoor, IL; Woodstock, IL; Rockford, IL; Machesney Park, IL; Huntley, IL; Freeport, IL; Fox Lake, IL; Dixon, IL… |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | |||
| Eyewear Supplier | 332H00000X | Yes |
Addresses
Primary practice location
1705 W Morton Ave
Jacksonville, IL 62650-2719
Mailing address
PO Box 19060
Green Bay, WI 54307-9060
Other names
- Shopko Optical 4140
Other providers in Jacksonville, IL
- Charles Milton Sheaff
- Catherine Sheeley
- Larry E Sherwin
- Shopko Stores Operating Co LLC
- Shopko Stores Operating Co. LLC
- Karen Sibert
- Cynthia Simpson
- Siu Physicians & Surgeons, Inc
- Denise L Skinner
- Michael Scott Slinkard
All providers in Jacksonville, IL · Eyewear Supplier in Illinois
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.