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General NPI Number Information
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NPI Number | 1356438808
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Entity Type | Organization
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Legal Business Name | SPECTACULAR EYE CARE LLC
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 509 S. CHERRY GROVE AVE SUITE C
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City | ANNAPOLIS
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State | MD
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Zip | 21401-4244
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Country | US
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Telephone | 410-268-4393
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Fax |
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Provider Business Mailing Address
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Address Line | 509 S CHERRY GROVE AVE SUITE C
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City | ANNAPOLIS
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State | MD
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Zip | 21401-4244
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Country | US
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Telephone | 410-268-4393
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. CARRIE HUBBELL
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Credential | OD
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Telephone | 410-268-4393
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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 | TA1798
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License Number State | MD
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