Organization
SPECTACLE SHOP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JON DAVID BRIGHT OPTICIAN (PRESIDENT)
(434) 973-8636
Entity
Organization
Contact information
Practice address
1047 MILLMONT ST, CHARLOTTESVILLE, VA 22903-4866
(434) 979-7730
(434) 977-7512
Mailing address
20251 LONG LAKE DRIVE, HAMMOND, LA 70403-8607
(985) 520-5005
(985) 520-5060
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
1101000736
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009280006
—
VA
Enumeration date
07/30/2006
Last updated
08/13/2021
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