MEDICARE: SHOPTIKAL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist
2	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1417513888
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHOPTIKAL LLC

Provider Business Mailing Address
First Line	:	PO BOX 19060
Second Line	:
City	:	GREEN BAY
State	:	WI
Zip	:	54307-9060
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6000 MONONA DR STE 101
Second Line	:
City	:	MONONA
State	:	WI
Zip	:	53716-3329
Country	:	US
Telephone Number	:	608-222-9420
Fax Number	:

Authorized Official
Title or Position	:	EVP & CFO
Name	:	RUSSELL STEINHORST
Credential	:
Telephone Number	:	920-429-7489

Provider Enumeration Date	:	05/11/2019
Last Update Date	:	11/29/2024

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Directions to “SHOPTIKAL LLC ” Practice Location

Language	Start Address	Practice Location

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