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General NPI Number Information
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NPI Number | 1386173847
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Entity Type | Organization
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Legal Business Name | SPECTACLE ENVY
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Dates
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Enumeration Date | 06/08/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 66 COURT SQ
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City | MOCKSVILLE
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State | NC
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Zip | 27028-2415
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Country | US
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Telephone | 336-231-3135
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Fax | 336-753-1335
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Provider Business Mailing Address
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Address Line | 66 COURT SQ
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City | MOCKSVILLE
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State | NC
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Zip | 27028-2415
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Country | US
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Telephone | 336-231-3135
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Fax | 336-753-1335
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Authorized Official
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Title or Position | OPTICIAN
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Name | KELLEY J TAYLOR
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Credential | NCLDO
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Telephone | 336-231-3135
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 2087
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License Number State | NC
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