NPIMap

Organization Active NPI

Spectacle Shoppe Inc.

  • Optometrist
  • Minneapolis, MN
National Provider Identifier
1386965770
Registry record updated Mar 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
SPECTACLE SHOPPE INC.
Practice address
2405 Hennepin Ave
Minneapolis, MN 55405-2606
Phone
(612) 584-4142
Fax
(612) 584-4147
NPI assigned
Jun 20, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2025

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

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X Primary
Eyewear Supplier 332H00000X

Addresses

Primary practice location

2405 Hennepin Ave
Minneapolis, MN 55405-2606

Mailing address

2405 Hennepin Ave
Minneapolis, MN 55405-2606
Phone (612) 584-4142

Other names 1

  • The Spectacle Shoppe Inc. Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100923001128 MN Part B Supplier - Clinic/Group Practice 1153447453 Receives reassigned benefits from 8 practitioners
4 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Minneapolis, MN; New Brighton, MN; Saint Paul, MN; St Louis Park, MN

Other NPIs on the same Medicare enrollment 4

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
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.

Practitioners & affiliated clinicians

Practitioners 1

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

NPI Registry JSON

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

{
    "created_epoch": "1276992000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742515200000",
    "number": "1386965770",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2405 HENNEPIN AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554052606",
            "telephone_number": "612-584-4142",
            "fax_number": "612-584-4147"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2405 HENNEPIN AVE",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554052606",
            "telephone_number": "612-584-4142",
            "fax_number": "612-584-4147"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPECTACLE SHOPPE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-06-20",
        "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": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Spectacle Shoppe Inc.",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "The Spectacle Shoppe Inc.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Minneapolis, MN

Sources for this page

  • 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.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.