Organization
GRAND SPECTACLE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KYLE MCDONOUGH ABOC (VICE-PRESIDENT)
(651) 227-8198
Entity
Organization
Contact information
Practice address
764 GRAND AVE, SAINT PAUL, MN 55105-3306
(651) 227-8198
Mailing address
764 GRAND AVE, SAINT PAUL, MN 55105-3306
(651) 227-8198
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Enumeration date
04/02/2012
Last updated
04/02/2012
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