Shoptikal LLC

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

Legal business name

SHOPTIKAL LLC

Doing business as

Shopko Optical 4072

Practice address

2331 Thain Grade Ste 101
Lewiston, ID 83501-4119

Phone

(208) 746-1050

NPI assigned

May 11, 2019

Organization subpart

No

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

Addresses

Other names 1

• Shopko Optical 4072 Doing business as

Medicare fee-for-service enrollment

Enrolled in ID

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

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

• Shoptikal LLC

  • Eyewear Supplier
  • Coeur D Alene, ID
  • NPI 1063078442

  O20190610000806

  Same enrollment

Tax ID family

Shoptikal LLC168 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 1

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

• Shoptikal LLC

  • Eyewear Supplier
  • Coeur D Alene, ID
  • NPI 1063078442
  NPD tax ID

Locations

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": "1972169357",
    "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": "2331 THAIN GRADE STE 101",
            "city": "LEWISTON",
            "state": "ID",
            "postal_code": "835014119",
            "telephone_number": "208-746-1050"
        }
    ],
    "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": "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 4072",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Shopko Optical 4072",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Angie A. Shantie, LCSW
• Chelsy Joy Sheppard, MSN, FNP, ARNP-C
• Mark Wilson Sheppard, D.D.S.
• Shopko Stores Operating Co LLC
• Shopko Stores Operating Co. LLC
• Frank E Shull, MED LCPC
• Karen Mae Silva, LCPC
• Kent B. Simmons, D.D.S.
• Simon Audiology & Tinnitus LLC
• Simon Hearing, LLC

• Eyewear Supplier in Lewiston, ID
• Providers in Lewiston, ID by specialty
• Eyewear Supplier in Idaho

• 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.