Provider Demographics
NPI:1093725103
Name:SPECTACULAR VISIONS LTD
Entity Type:Organization
Organization Name:SPECTACULAR VISIONS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:ARNESON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-823-2020
Mailing Address - Street 1:136 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CLINTONVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:54929-1631
Mailing Address - Country:US
Mailing Address - Phone:715-823-2020
Mailing Address - Fax:715-823-7124
Practice Address - Street 1:136 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CLINTONVILLE
Practice Address - State:WI
Practice Address - Zip Code:54929-1631
Practice Address - Country:US
Practice Address - Phone:715-823-2020
Practice Address - Fax:715-823-7124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2013-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI87710Medicare ID - Type Unspecified
WI0409810001Medicare NSC