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General NPI Number Information
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NPI Number | 1134690811
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Entity Type | Organization
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Legal Business Name | SPECTACLE OPTOMETRY, INC.
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Dates
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Enumeration Date | 12/06/2018
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Last Update Date | 12/06/2018
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Provider Practice Location Address
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Address Line | 5655 E LA PALMA AVE STE 150
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City | ANAHEIM
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State | CA
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Zip | 92807-2122
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Country | US
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Telephone | 714-595-5130
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Fax |
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Provider Business Mailing Address
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Address Line | 18119 BURKE LN
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City | YORBA LINDA
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State | CA
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Zip | 92886-8680
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | COURTNEY BOVY
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Credential |
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Telephone | 714-595-5130
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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