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General NPI Number Information
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NPI Number | 1174138168
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Entity Type | Organization
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Legal Business Name | SHOPTIKAL LLC
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Dates
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Enumeration Date | 09/15/2020
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Last Update Date | 11/29/2024
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Provider Practice Location Address
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Address Line | 1550 W LANE RD
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City | MACHESNEY PARK
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State | IL
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Zip | 61115-1903
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Country | US
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Telephone | 815-668-0533
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 19060
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City | GREEN BAY
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State | WI
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Zip | 54307-9060
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Country | US
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Telephone | 920-429-7842
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Fax |
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Authorized Official
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Title or Position | EVP & CFO
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Name | RUSSELL STEINHORST
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Credential |
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Telephone | 920-429-7489
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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