Provider Demographics
NPI:1588700157
Name:SPECTACLE SHOPPE INC.
Entity type:Organization
Organization Name:SPECTACLE SHOPPE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL/COO
Authorized Official - Prefix:
Authorized Official - First Name:BETH
Authorized Official - Middle Name:SEATON
Authorized Official - Last Name:ULRICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-636-3434
Mailing Address - Street 1:2050 SILVER LK RD
Mailing Address - Street 2:
Mailing Address - City:NEW BRIGHTON
Mailing Address - State:MN
Mailing Address - Zip Code:55112
Mailing Address - Country:US
Mailing Address - Phone:651-636-3434
Mailing Address - Fax:651-636-4999
Practice Address - Street 1:2050 SILVER LAKE RD NW
Practice Address - Street 2:
Practice Address - City:NEW BRIGHTON
Practice Address - State:MN
Practice Address - Zip Code:55112-5301
Practice Address - Country:US
Practice Address - Phone:651-636-3434
Practice Address - Fax:651-636-4999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN3C44OSPOtherBCBS
MN40747OtherPREFERRED ONE