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General NPI Number Information
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NPI Number | 1215942792
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Entity Type | Organization
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Legal Business Name | SPECTACLE SHOP, INC.
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Dates
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Enumeration Date | 07/30/2006
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Last Update Date | 08/13/2021
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Provider Practice Location Address
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Address Line | 1047 MILLMONT ST
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City | CHARLOTTESVILLE
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State | VA
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Zip | 22903-4866
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Country | US
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Telephone | 434-979-7730
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Fax | 434-977-7512
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Provider Business Mailing Address
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Address Line | 20251 LONG LAKE DRIVE
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City | HAMMOND
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State | LA
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Zip | 70403-8607
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Country | US
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Telephone | 985-520-5005
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Fax | 985-520-5060
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JON DAVID BRIGHT
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Credential | OPTICIAN
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Telephone | 434-973-8636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 1101000736
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License Number State | VA
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