Provider Demographics
NPI:1053507319
Name:SPECTACLES INC.
Entity Type:Organization
Organization Name:SPECTACLES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:E
Authorized Official - Last Name:REICHERT
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSED OPTICIAN
Authorized Official - Phone:910-864-2700
Mailing Address - Street 1:5924 CLIFFDALE RD STE 112A
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-0035
Mailing Address - Country:US
Mailing Address - Phone:910-864-2700
Mailing Address - Fax:910-864-3000
Practice Address - Street 1:5924 CLIFFDALE RD STE 112A
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-0035
Practice Address - Country:US
Practice Address - Phone:910-864-2700
Practice Address - Fax:910-864-3000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8802035Medicaid