Organization
GRAND SPECTACLE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MATTHEW MCDONOUGH ABOM, NCLE (CERTIFIED OPTICIAN)
(651) 227-8198
Entity
Organization
Contact information
Practice address
764 GRAND AVE, SAINT PAUL, MN 55105-3306
(651) 227-8198
(651) 227-8198
Mailing address
764 GRAND AVE, SAINT PAUL, MN 55105-3306
(651) 227-8198
(651) 227-8198
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
—
—
Other
Enumeration date
03/29/2007
Last updated
08/22/2020
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