Healthcare Provider Details

I. General information

NPI: 1609770825
Provider Name (Legal Business Name): EYEGLASS SPOT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2026
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 N MAIN ST
HUTCHINSON KS
67501-4402
US

IV. Provider business mailing address

904 N MAIN ST
HUTCHINSON KS
67501-4402
US

V. Phone/Fax

Practice location:
  • Phone: 620-302-1021
  • Fax: 620-302-1021
Mailing address:
  • Phone: 620-302-1021
  • Fax: 620-302-1021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JENNIFER DAVIS
Title or Position: OWNER
Credential: CERTIFIED OPTICIAN
Phone: 620-302-1021