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NPI Code Detail

MEDICARE: SHOPTIKAL LLC

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
1152W00000XOptometrist
2332H00000XEyewear Supplier

General Provider Information

NPI Number : 1639784622
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 : 920-429-7842
Fax Number :
Provider Business Practice Location Address
First Line : 2268 W MASON ST
Second Line :
City : GREEN BAY
State : WI
Zip : 54303-4707
Country : US
Telephone Number : 920-259-7068
Fax Number :
Authorized Official
Title or Position : EVP & CFO
Name : RUSSELL STEINHORST
Credential :
Telephone Number : 920-429-7489
Provider Enumeration Date : 09/15/2020
Last Update Date : 11/29/2024

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Directions to “SHOPTIKAL LLC ” Practice Location

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