Healthcare Provider Details

I. General information

NPI: 1073995783
Provider Name (Legal Business Name): SPEC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2015
Last Update Date: 06/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 HERRICK ST UNIT 102
BEVERLY MA
01915-2734
US

IV. Provider business mailing address

77 HERRICK ST UNIT 102
BEVERLY MA
01915-2734
US

V. Phone/Fax

Practice location:
  • Phone: 978-338-4321
  • Fax:
Mailing address:
  • Phone: 978-338-4321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIELLE MONIQUE LEDOUX
Title or Position: PRESIDENT
Credential: MD
Phone: 617-650-9997