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General NPI Number Information
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NPI Number | 1821688268
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Entity Type | Organization
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Legal Business Name | SPECTACLE, LLC
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Dates
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Enumeration Date | 01/20/2021
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Last Update Date | 01/20/2021
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Provider Practice Location Address
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Address Line | 2201 COBB PKWY SE
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City | SMYRNA
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State | GA
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Zip | 30080-7629
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Country | US
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Telephone | 770-250-7510
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Fax | 770-953-4113
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Provider Business Mailing Address
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Address Line | 509 KEELER WOODS DR NW
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City | MARIETTA
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State | GA
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Zip | 30064-2022
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. JESSICA HALL
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Credential | OD
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Telephone | 404-218-8473
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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 |
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License Number State |
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