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General NPI Number Information
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NPI Number | 1275712176
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Entity Type | Organization
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Legal Business Name | SMART SPECS OPTICAL, LLC
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Dates
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Enumeration Date | 10/26/2007
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Last Update Date | 11/17/2010
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Provider Practice Location Address
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Address Line | 900 N SAN FRANCISCO ST
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-3236
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Country | US
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Telephone | 928-779-7000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 30003
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City | FLAGSTAFF
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State | AZ
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Zip | 86003-0003
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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 | MANAGER
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Name | MELISSA DUNSTAN
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Credential |
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Telephone | 928-779-7000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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