Organization
SPECTACLE SHOPPE INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BETH SEATON ULRICH (AUTHORIZED OFFICAL/COO)
(651) 636-3434
Entity
Organization
Contact information
Practice address
1089 GRAND AVE, SAINT PAUL, MN 55105-3002
(651) 797-4834
(651) 788-9153
Mailing address
2050 SILVER LAKE RD NW, NEW BRIGHTON, MN 55112-5301
(651) 797-4834
(651) 788-9153
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
332H00000X
Eyewear Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6C261SP
BCBS
MN
01
—
93268
PREFERRED ONE
MN
Enumeration date
01/31/2007
Last updated
03/21/2025
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