Organization
SPECTACLE SHOPPE INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BETH SEATON ULRICH (AUTHORIZED OFFICIAL/COO)
(651) 636-3434
Entity
Organization
Contact information
Practice address
2050 SILVER LAKE RD NW, NEW BRIGHTON, MN 55112-5301
(651) 636-3434
(651) 636-4999
Mailing address
2050 SILVER LK RD, NEW BRIGHTON, MN 55112
(651) 636-3434
(651) 636-4999
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
332H00000X
Eyewear Supplier
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3C44OSP
BCBS
MN
01
—
40747
PREFERRED ONE
MN
Enumeration date
01/30/2007
Last updated
03/21/2025
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