Spectacle Shoppe Inc.

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

SPECTACLE SHOPPE INC.

Practice address

1089 Grand Ave
Saint Paul, MN 55105-3002

Phone

(651) 797-4834

Fax

(651) 788-9153

NPI assigned

Jan 31, 2007

Organization subpart

No

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

Authorized official

Name

Beth Seaton Ulrich

Title

Authorized Offical/Coo

Phone

(651) 636-3434

Specialties & licenses 2

Addresses

Other identifiers 2

Tax ID family

Spectacle Shoppe Inc6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

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

• Spectacle Shoppe Inc.

  • Optometrist
  • Minneapolis, MN
  • NPI 1386965770
  NPD tax ID
• Spectacle Shoppe Inc.

  • Optometrist
  • St Louis Park, MN
  • NPI 1568118545
  NPD tax ID
• Spectacle Shoppe Inc.

  • Optometrist
  • New Brighton, MN
  • NPI 1588700157
  NPD tax ID
• The Spectacle Shoppe Inc

  • Optometrist
  • Burnsville, MN
  • NPI 1235457722
  NPD tax ID
• The Spectacle Shoppe Inc

  • Optometrist
  • Saint Paul, MN
  • NPI 1912224767
  NPD tax ID

Locations

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

{
    "created_epoch": "1170201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742515200000",
    "number": "1376680165",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2050 SILVER LAKE RD NW",
            "city": "NEW BRIGHTON",
            "state": "MN",
            "postal_code": "551125301",
            "telephone_number": "651-797-4834",
            "fax_number": "651-788-9153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1089 GRAND AVE",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551053002",
            "telephone_number": "651-797-4834",
            "fax_number": "651-788-9153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECTACLE SHOPPE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-31",
        "last_updated": "2025-03-21",
        "certification_date": "2025-03-21",
        "status": "A",
        "authorized_official_last_name": "ULRICH",
        "authorized_official_first_name": "BETH",
        "authorized_official_middle_name": "SEATON",
        "authorized_official_title_or_position": "AUTHORIZED OFFICAL/COO",
        "authorized_official_telephone_number": "651-636-3434"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "6C261SP",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED ONE",
            "identifier": "93268",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Optometrist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2025; 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.