Healthcare Provider Details

I. General information

NPI: 1710512801
Provider Name (Legal Business Name): SHOPTIKAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2020
Last Update Date: 02/28/2026
Certification Date: 02/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9940 N IL ROUTE 47
HUNTLEY IL
60142-9325
US

IV. Provider business mailing address

PO BOX 19060
GREEN BAY WI
54307-9060
US

V. Phone/Fax

Practice location:
  • Phone: 847-802-8788
  • Fax:
Mailing address:
  • Phone: 920-429-7842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateNULL

VIII. Authorized Official

Name: RUSSELL STEINHORST
Title or Position: CEO
Credential:
Phone: 920-429-7285