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General NPI Number Information
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NPI Number | 1659397024
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Entity Type | Organization
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Legal Business Name | SPECS OPTICAL LLC
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Dates
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Enumeration Date | 07/15/2006
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Last Update Date | 07/08/2019
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Provider Practice Location Address
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Address Line | 110 31ST AVE N APT 404
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City | NASHVILLE
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State | TN
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Zip | 37203-1530
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Country | US
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Telephone | 615-329-3959
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Fax | 615-320-6033
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Provider Business Mailing Address
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Address Line | 110 31ST AVE N APT 404
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City | NASHVILLE
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State | TN
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Zip | 37203-1530
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Country | US
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Telephone | 615-329-3959
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Fax | 615-320-6033
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Authorized Official
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Title or Position | MEMBER
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Name | MS. SUSAN K KISTLER
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Credential | LDO
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Telephone | 615-329-3959
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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 | TN
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