Shopko Optical 4017 - Medicare in Saint Cloud, MN

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Shopko Optical 4017 is a medicare enrolled "Eyewear Supplier" provider in Saint Cloud, Minnesota. Their current practice location is 4051 W Division St Ste A, Saint Cloud, Minnesota. You can reach out to their office (for appointments etc.) via phone at (320) 253-5994.

Shopko Optical 4017 is licensed to practice in * (Not Available) (license number ) and it also participates in the medicare program. Shopko Optical 4017 is enrolled with medicare and should accept medicare assignments and since they are enrolled in medicare, they may order Medicare Part D Prescription drugs, if eligible. The facility's NPI Number is 1942866371.

Contact Information

Shopko Optical 4017
4051 W Division St Ste A,
Saint Cloud, MN 56301-3741
(320) 253-5994
Not Available

Map and Direction




Healthcare Provider's Profile

Full NameShopko Optical 4017
TypeFacility
SpecialityEyewear Supplier
Location4051 W Division St Ste A, Saint Cloud, Minnesota
Accepts Medicare AssignmentsMedicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs.
  NPI Data:
  • NPI Number: 1942866371
  • Provider Enumeration Date: 05/10/2019
  • Last Update Date: 11/29/2024
  Medicare PECOS Information:
  • PECOS PAC ID: 1456684471
  • Enrollment ID: O20190611002309

Medical Identifiers

Medical identifiers for Shopko Optical 4017 such as npi, medicare ID, medicare PIN, medicaid, etc.
IdentifierTypeStateIssuer
1942866371NPI-NPPES

Medical Taxonomies and Licenses

TaxonomyTypeLicense (State)Status
152W00000XOptometrist (* (Not Available))Secondary
332H00000XEyewear Supplier (* (Not Available))Primary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Shopko Optical 4017 acts as a billing entity for following providers:
Provider NameEric L Saksa
Provider TypePractitioner - Optometry
Provider IdentifiersNPI Number: 1558477893
PECOS PAC ID: 0749180578
Enrollment ID: I20040109000390
Provider NameAra C Gerard
Provider TypePractitioner - Optometry
Provider IdentifiersNPI Number: 1841356532
PECOS PAC ID: 1254234636
Enrollment ID: I20040202000257
Provider NameJames B Connelly
Provider TypePractitioner - Optometry
Provider IdentifiersNPI Number: 1508884016
PECOS PAC ID: 2769474311
Enrollment ID: I20040401001540
Provider NameJoseph J Kisch
Provider TypePractitioner - Optometry
Provider IdentifiersNPI Number: 1982713012
PECOS PAC ID: 5799767919
Enrollment ID: I20040602000943
Provider NameLeann Sundhagen
Provider TypePractitioner - Optometry
Provider IdentifiersNPI Number: 1770694986
PECOS PAC ID: 8325021108
Enrollment ID: I20040611000717
Provider NameLarry J Schlauderaff
Provider TypePractitioner - Optometry
Provider IdentifiersNPI Number: 1477748085
PECOS PAC ID: 0446221154
Enrollment ID: I20040817000514
Provider NameJames T Hess
Provider TypePractitioner - Optometry
Provider IdentifiersNPI Number: 1720017304
PECOS PAC ID: 8426003724
Enrollment ID: I20050321000206
Provider NameRobert T Mccamy
Provider TypePractitioner - Optometry
Provider IdentifiersNPI Number: 1497892335
PECOS PAC ID: 7517904097
Enrollment ID: I20050415000524
Provider NameChristine A Olmsted
Provider TypePractitioner - Optometry
Provider IdentifiersNPI Number: 1306884580
PECOS PAC ID: 4981635455
Enrollment ID: I20050825000071
Provider NameMark D Olmsted
Provider TypePractitioner - Optometry
Provider IdentifiersNPI Number: 1699713883
PECOS PAC ID: 0446281919
Enrollment ID: I20050825000085
Provider NamePaul Dubbels
Provider TypePractitioner - Optometry
Provider IdentifiersNPI Number: 1235339953
PECOS PAC ID: 8426089764
Enrollment ID: I20050825000874
Provider NameColleen N Konkel
Provider TypePractitioner - Optometry
Provider IdentifiersNPI Number: 1528018975
PECOS PAC ID: 4587693460
Enrollment ID: I20060127000471
Provider NameKenneth Ristau
Provider TypePractitioner - Optometry
Provider IdentifiersNPI Number: 1235180233
PECOS PAC ID: 5092727586
Enrollment ID: I20060627000337
Provider NameBryan D Lorenz
Provider TypePractitioner - Optometry
Provider IdentifiersNPI Number: 1881634806
PECOS PAC ID: 3476566464
Enrollment ID: I20060714000276
Provider NameLonda L Fischer Costello
Provider TypePractitioner - Optometry
Provider IdentifiersNPI Number: 1942401039
PECOS PAC ID: 5799879771
Enrollment ID: I20070921000127
Provider NameMichael B Fisher
Provider TypePractitioner - Optometry
Provider IdentifiersNPI Number: 1891884771
PECOS PAC ID: 8325134117
Enrollment ID: I20080124000219
Provider NameScott Pastryk
Provider TypePractitioner - Optometry
Provider IdentifiersNPI Number: 1063499762
PECOS PAC ID: 6002885365
Enrollment ID: I20080318000281
Provider NameRobert C Hochhalter
Provider TypePractitioner - Optometry
Provider IdentifiersNPI Number: 1902878127
PECOS PAC ID: 5890844013
Enrollment ID: I20090519000262
Provider NameApril A Austing
Provider TypePractitioner - Optometry
Provider IdentifiersNPI Number: 1427288554
PECOS PAC ID: 1254486582
Enrollment ID: I20090909000690
Provider NameAlaina L Softing Hataye
Provider TypePractitioner - Optometry
Provider IdentifiersNPI Number: 1427155654
PECOS PAC ID: 3375680077
Enrollment ID: I20091029000419
Provider NameJacqueline A Jones
Provider TypePractitioner - Optometry
Provider IdentifiersNPI Number: 1023090396
PECOS PAC ID: 0345380879
Enrollment ID: I20091215000113
Provider NameKristina A Voyna
Provider TypePractitioner - Optometry
Provider IdentifiersNPI Number: 1457303505
PECOS PAC ID: 3971506627
Enrollment ID: I20110429000559
Provider NameGareth S Hataye
Provider TypePractitioner - Optometry
Provider IdentifiersNPI Number: 1164529384
PECOS PAC ID: 1658418355
Enrollment ID: I20120118000302
Provider NameJacob Bollman
Provider TypePractitioner - Optometry
Provider IdentifiersNPI Number: 1811336043
PECOS PAC ID: 3274767454
Enrollment ID: I20131001000083
Provider NameLois M Meacham
Provider TypePractitioner - Optometry
Provider IdentifiersNPI Number: 1902929391
PECOS PAC ID: 6709014111
Enrollment ID: I20140110000351
Provider NameJenna K Backowski
Provider TypePractitioner - Optometry
Provider IdentifiersNPI Number: 1831502244
PECOS PAC ID: 8820212525
Enrollment ID: I20140620000095
Provider NameMelissa Anna Shaffer
Provider TypePractitioner - Optometry
Provider IdentifiersNPI Number: 1285833624
PECOS PAC ID: 5395830335
Enrollment ID: I20150918000124
Provider NameAshley L Walkoviak
Provider TypePractitioner - Optometry
Provider IdentifiersNPI Number: 1043699317
PECOS PAC ID: 0244547347
Enrollment ID: I20150922003347
Provider NameAimee Violette
Provider TypePractitioner - Optometry
Provider IdentifiersNPI Number: 1578026738
PECOS PAC ID: 3173859881
Enrollment ID: I20200601001107
Provider NameSteven Laliberte
Provider TypePractitioner - Optometry
Provider IdentifiersNPI Number: 1467442582
PECOS PAC ID: 8224926829
Enrollment ID: I20200803002908
Provider NameBrianne Herlitzke
Provider TypePractitioner - Optometry
Provider IdentifiersNPI Number: 1992268551
PECOS PAC ID: 8022342229
Enrollment ID: I20200929002812
Provider NameAdam M Peters
Provider TypePractitioner - Optometry
Provider IdentifiersNPI Number: 1851063952
PECOS PAC ID: 6103215116
Enrollment ID: I20220125000744
Provider NameJosephine R Ausdemore
Provider TypePractitioner - Optometry
Provider IdentifiersNPI Number: 1104564269
PECOS PAC ID: 3678954856
Enrollment ID: I20220719002966
Provider NameSamuel Elijah Lupkes
Provider TypePractitioner - Optometry
Provider IdentifiersNPI Number: 1689382020
PECOS PAC ID: 0244609238
Enrollment ID: I20221214001362
Provider NameWendy Lawson Kopp
Provider TypePractitioner - Optometry
Provider IdentifiersNPI Number: 1669581765
PECOS PAC ID: 6507858503
Enrollment ID: I20230623001182
Provider NameStephen Sternitzky
Provider TypePractitioner - Optometry
Provider IdentifiersNPI Number: 1790768968
PECOS PAC ID: 3971628736
Enrollment ID: I20231102003892
Provider NameMark Mixan
Provider TypePractitioner - Optometry
Provider IdentifiersNPI Number: 1093197204
PECOS PAC ID: 2961716006
Enrollment ID: I20250509001778
Provider NameDavid Bellware
Provider TypePractitioner - Optometry
Provider IdentifiersNPI Number: 1255397329
PECOS PAC ID: 3971637182
Enrollment ID: I20251125004376
Provider NameMathew Mergenthaler
Provider TypePractitioner - Optometry
Provider IdentifiersNPI Number: 1568874907
PECOS PAC ID: 8921226879
Enrollment ID: I20260126001556

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Shopko Optical 4017 is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing AddressPractice Location Address
Shopko Optical 4017
Po Box 19060,
Green Bay, WI 54307-9060

Ph: Not Available		Shopko Optical 4017
4051 W Division St Ste A,
Saint Cloud, MN 56301-3741

Ph: (320) 253-5994

Reviews and Comments



Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. This program also covers certain younger people with disabilities (who receive Social Security Disability Insurance - SSDI), and people with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD.

Medicare Assignment: Assignment means that your doctor, provider, or supplier agrees (or is required by law) to accept the Medicare-approved amount as full payment for covered services. Most doctors, providers, and suppliers accept assignment, but you should always check to make sure. Participating providers have signed an agreement to accept assignment for all Medicare-covered services.

NPI Number: The National Provider Identifier (NPI) is a unique identification number for covered health care providers. The NPI must be used in lieu of legacy provider identifiers in the HIPAA standards transactions. Covered health care providers and all health plans and health care clearinghouses must use the NPIs in the administrative and financial transactions adopted under HIPAA (Health Insurance Portability and Accountability Act).

Our Data: Information on www.medicarelist.com is built using data sources published by Centers for Medicare & Medicaid Services (CMS) under Freedom of Information Act (FOIA). The information disclosed on the NPI Registry are FOIA-disclosable and are required to be disclosed under the FOIA and the eFOIA amendments to the FOIA. There is no way to 'opt out' or 'suppress' the NPPES record data for health care providers with active NPIs.