Grand Spectacle Inc

Primary specialty

OpticianTaxonomy code 156FX1800X

Legal business name

GRAND SPECTACLE INC

Practice address

764 Grand Ave
Saint Paul, MN 55105-3306

Phone

(651) 227-8198

Fax

(651) 227-8198

NPI assigned

Mar 29, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Matthew McDonough, ABOM, NCLE

Title

Certified Optician

Phone

(651) 227-8198

Specialties & licenses 1

Addresses

Tax ID family

Grand Spectacle Inc2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Grand Spectacle Inc

  • Optometrist
  • Saint Paul, MN
  • NPI 1346506581
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Thomas R Barber, O.D.

  • Optometrist
  • Saint Paul, MN
  • NPI 1972622710
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1003935867",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "764 GRAND AVE",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551053306",
            "telephone_number": "651-227-8198",
            "fax_number": "651-227-8198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "764 GRAND AVE",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551053306",
            "telephone_number": "651-227-8198",
            "fax_number": "651-227-8198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND SPECTACLE INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MCDONOUGH",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "CERTIFIED OPTICIAN",
        "authorized_official_telephone_number": "651-227-8198",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "ABOM, NCLE"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Technician/Technologist, Optician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Grand Avenue Dental, LLC
• Grand Avenue Smiles
• Grand Dental Care, PLLC
• Grand Ethnic Minnesota Home Care LLC
• Grand Health Chiropractic and Wellness Center, P.a.
• Grand Spectacle Inc
• Grand St Paul CVS LLC
• Grand St Paul CVS LLC
• Grand St Paul CVS LLC
• Grand St Paul CVS LLC

• All providers in Saint Paul, MN
• Optician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.