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General NPI Number Information
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NPI Number | 1376680165
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Entity Type | Organization
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Legal Business Name | SPECTACLE SHOPPE INC.
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 03/21/2025
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Provider Practice Location Address
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Address Line | 1089 GRAND AVE
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City | SAINT PAUL
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State | MN
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Zip | 55105-3002
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Country | US
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Telephone | 651-797-4834
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Fax | 651-788-9153
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Provider Business Mailing Address
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Address Line | 2050 SILVER LAKE RD NW
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City | NEW BRIGHTON
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State | MN
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Zip | 55112-5301
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Country | US
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Telephone | 651-797-4834
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Fax | 651-788-9153
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Authorized Official
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Title or Position | AUTHORIZED OFFICAL/COO
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Name | BETH SEATON ULRICH
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Credential |
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Telephone | 651-636-3434
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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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Taxonomy #2
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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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