Active NPI
Shoptikal LLC
- Eyewear Supplier
- Taylorville, IL
National Provider Identifier
1891454583
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Eyewear Supplier
- Legal business name
- SHOPTIKAL LLC
- Practice address
- 1528 W Springfield Rd
Taylorville, IL 62568-2756 - Phone
- (217) 777-9963
- NPI assigned
- Dec 10, 2021
- 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 |
|---|---|---|---|---|
| Optometrist | 152W00000X | |||
| Eyewear Supplier | 332H00000X | Primary |
Addresses
Primary practice location
1528 W Springfield Rd
Taylorville, IL 62568-2756
Mailing address
PO Box 19060
Green Bay, WI 54307-9060
Phone (920) 429-2211
Other names 1
- Shopko Optical 4261
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| 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… |
Other NPIs on the same Medicare enrollment 17
NPIs listed together on one Medicare enrollment, typically parts of the same organization.
National Provider Directory
National Provider DirectoryLocations
1528 W Springfield Rd
Taylorville, IL 62568
Phone (217) 777-9963
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Optometrist
- Lombard, IL
- NPI 1336290253
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1639094400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1732838400000",
"number": "1891454583",
"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",
"telephone_number": "920-429-2211"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1528 W SPRINGFIELD RD",
"city": "TAYLORVILLE",
"state": "IL",
"postal_code": "625682756",
"telephone_number": "217-777-9963"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "SHOPTIKAL LLC",
"organizational_subpart": "NO",
"enumeration_date": "2021-12-10",
"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": "152W00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Optometrist",
"state": null,
"license": null,
"primary": false
},
{
"code": "332H00000X",
"taxonomy_group": "",
"desc": "Eyewear Supplier",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Shopko Optical 4261",
"code": "3",
"type": "Doing Business As"
},
{
"organization_name": "Shopko Optical 4261",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Taylorville, 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.