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General NPI Number Information
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NPI Number | 1497949002
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Entity Type | Organization
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Legal Business Name | SPECTICCA INC
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Dates
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Enumeration Date | 08/28/2007
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Last Update Date | 03/17/2011
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Provider Practice Location Address
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Address Line | 319 N HIGGINS AVE
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City | MISSOULA
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State | MT
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Zip | 59802-4537
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Country | US
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Telephone | 406-549-5700
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Fax |
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Provider Business Mailing Address
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Address Line | 319 N HIGGINS AVE
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City | MISSOULA
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State | MT
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Zip | 59802-4537
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Country | US
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Telephone | 406-549-5700
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Fax |
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Authorized Official
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Title or Position | OPTICIAN/OWNER
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Name | MR. CLAUDE HUGUET
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Credential |
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Telephone | 406-549-5700
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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 | BL01-9385
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License Number State | MT
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