Provider Demographics
NPI:1063517373
Name:SPECTACULAR EYEWEAR
Entity type:Organization
Organization Name:SPECTACULAR EYEWEAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:E
Authorized Official - Last Name:ESKRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-699-4444
Mailing Address - Street 1:940 S QUEEN ST
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-3946
Mailing Address - Country:US
Mailing Address - Phone:717-699-4444
Mailing Address - Fax:717-854-9543
Practice Address - Street 1:940 S QUEEN ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-3946
Practice Address - Country:US
Practice Address - Phone:717-699-4444
Practice Address - Fax:717-854-9543
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA243997OtherBLUE SHIELD
PA50010000OtherCAPITAL BLUE CROSS
PA1267710001Medicare ID - Type Unspecified