NPIMap

Organization Active NPI

The Spectacle Shoppe Inc

  • Optometrist
  • Saint Paul, MN
National Provider Identifier
1912224767
Registry record updated Apr 11, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
0136 Issued in MN
Legal business name
THE SPECTACLE SHOPPE INC
Practice address
1089 Grand Ave
Saint Paul, MN 55105-3002
Phone
(651) 797-4834
Fax
(651) 788-9153
NPI assigned
May 3, 2010
Last updated
Apr 11, 2016By the provider in NPPES
Organization subpart
Yes
Parent organization
THE SPECTACLE SHOPPE INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 11, 2016

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

Authorized official

Name
Mr. David Ulrich
Title
Owner
Phone
(651) 636-3434

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 0136 MN Primary

Addresses

Primary practice location

1089 Grand Ave
Saint Paul, MN 55105-3002

Mailing address

1089 Grand Ave
Saint Paul, MN 55105-3002
Phone (651) 797-4834

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
The Spectacle Shoppe Inc6 organizations share this tax ID, including this one
Part of
The Spectacle Shoppe Inc

Other organizations with this tax ID 5

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

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1272844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1460332800000",
    "number": "1912224767",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "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"
        },
        {
            "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": "THE SPECTACLE SHOPPE INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE SPECTACLE SHOPPE INC",
        "enumeration_date": "2010-05-03",
        "last_updated": "2016-04-11",
        "status": "A",
        "authorized_official_last_name": "ULRICH",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "651-636-3434",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MN",
            "license": "0136",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2016; 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.