Spectacle Shop LLC

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

Legal business name

SPECTACLE SHOP LLC

Practice address

415 W 3Rd St
Yankton, SD 57078-4201

Phone

(605) 665-9638

Fax

(605) 665-0526

NPI assigned

Sep 29, 2005

Last updated

Sep 19, 2023By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Ms. Hailey Schelling

Title

Manager

Phone

(605) 665-9638

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• The Spectacle Shop LLC Other name

Medicare fee-for-service enrollment

Enrolled in SD

Enrollment records 1

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Spectacle Shop LLC

  • Eyewear Supplier
  • Creighton, NE
  • NPI 1730884321

  4486971918

  Same PAC ID
• Spectacle Shop LLC

  • Eyewear Supplier
  • Hartington, NE
  • NPI 1982309571

  4486971918

  Same PAC ID

Tax ID family

Spectacle Shop LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

• Spectacle Shop LLC

  • Eyewear Supplier
  • Creighton, NE
  • NPI 1730884321
  NPD tax ID
• Spectacle Shop LLC

  • Eyewear Supplier
  • Hartington, NE
  • NPI 1982309571
  NPD tax ID

Locations

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

{
    "created_epoch": "1127952000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695081600000",
    "number": "1992792600",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 819",
            "address_2": "415 W 3RD ST",
            "city": "YANKTON",
            "state": "SD",
            "postal_code": "570780819",
            "telephone_number": "605-665-9638",
            "fax_number": "605-665-0526"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 W 3RD ST",
            "city": "YANKTON",
            "state": "SD",
            "postal_code": "570784201",
            "telephone_number": "605-665-9638",
            "fax_number": "605-665-0526"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "202 S Robinson Ave",
            "address_purpose": "LOCATION",
            "city": "Hartington",
            "state": "NE",
            "postal_code": "687395501",
            "country_code": "US",
            "telephone_number": "402-254-2020",
            "fax_number": "402-254-7122",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "817 Main St",
            "address_purpose": "LOCATION",
            "city": "Creighton",
            "state": "NE",
            "postal_code": "687294003",
            "country_code": "US",
            "telephone_number": "402-358-3700",
            "fax_number": "402-358-3700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "SPECTACLE SHOP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-09-29",
        "last_updated": "2023-09-19",
        "certification_date": "2023-09-19",
        "status": "A",
        "authorized_official_last_name": "SCHELLING",
        "authorized_official_first_name": "HAILEY",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "605-665-9638",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9281510",
            "state": "SD"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100249545-00",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Spectacle Shop LLC",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "The Spectacle Shop LLC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Brenna Sokol, PT
• Ramesh Babu Somepalli, MD
• Dan Lee Somsen, RPH
• South Dakota Anesthesia Services PC
• South Dakota Human Services Center Pharmacy
• Elizabeth Sumner Spivey, PHD
• Sydney Stamatovich
• Sally Stanage
• Thomas S Stanage, PHD
• State of South Dakota (SD Human Services Center)

• Eyewear Supplier in Yankton, SD
• Providers in Yankton, SD by specialty
• Eyewear Supplier in South Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2023; 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.