NPIMap

Organization Active NPI

Shoptikal LLC

Doing business as Shopko Optical 4140

  • Eyewear Supplier
  • Jacksonville, IL
National Provider Identifier
1760048151
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 4140
Practice address
1705 W Morton Ave
Jacksonville, IL 62650-2719
Phone
(217) 245-6070
NPI assigned
May 12, 2019
Last updated
Nov 29, 2024By the provider in NPPES
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
Eyewear Supplier 332H00000X Primary
Optometrist 152W00000X

Addresses

Primary practice location

1705 W Morton Ave
Jacksonville, IL 62650-2719

Mailing address

PO Box 19060
Green Bay, WI 54307-9060

Other names 1

  • Shopko Optical 4140 Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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…

Other NPIs on the same Medicare enrollment 17

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

View all 17

National Provider Directory

National Provider Directory

Locations

1705 W Morton Ave
Jacksonville, IL 62650
Phone (217) 245-6070

Practitioners & affiliated clinicians

Practitioners 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1557619200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1732838400000",
    "number": "1760048151",
    "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": "1705 W MORTON AVE",
            "city": "JACKSONVILLE",
            "state": "IL",
            "postal_code": "626502719",
            "telephone_number": "217-245-6070"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHOPTIKAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-05-12",
        "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 4140",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Shopko Optical 4140",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jacksonville, IL

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.