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NPI Code Detail

MEDICARE: SPECTACLE SHOP LLC

MEDICARE: SPECTACLE SHOP LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332H00000XEyewear Supplier

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1992792600
Entity Type Code : Organization
Provider Name (Legal Business Name) : SPECTACLE SHOP LLC
Provider Business Mailing Address
First Line : PO BOX 819
Second Line : 415 W 3RD ST
City : YANKTON
State : SD
Zip : 57078-0819
Country : US
Telephone Number : 605-665-9638
Fax Number : 605-665-0526
Provider Business Practice Location Address
First Line : 415 W 3RD ST
Second Line :
City : YANKTON
State : SD
Zip : 57078-4201
Country : US
Telephone Number : 605-665-9638
Fax Number : 605-665-0526
Authorized Official
Title or Position : MANAGER
Name : MS. HAILEY SCHELLING
Credential :
Telephone Number : 605-665-9638
Provider Enumeration Date : 09/29/2005
Last Update Date : 09/19/2023

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Directions to “SPECTACLE SHOP LLC ” Practice Location

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