Provider Demographics
NPI:1275654626
Name:PERSPECTACLES
Entity Type:Organization
Organization Name:PERSPECTACLES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DISPENSING OPTICIAN
Authorized Official - Phone:831-625-2299
Mailing Address - Street 1:PO BOX 7478
Mailing Address - Street 2:
Mailing Address - City:CARMEL BY THE SEA
Mailing Address - State:CA
Mailing Address - Zip Code:93921
Mailing Address - Country:US
Mailing Address - Phone:831-625-2299
Mailing Address - Fax:831-625-2298
Practice Address - Street 1:SAN CARLOS & 7TH
Practice Address - Street 2:
Practice Address - City:CARMEL BY THE SEA
Practice Address - State:CA
Practice Address - Zip Code:93921
Practice Address - Country:US
Practice Address - Phone:831-625-2299
Practice Address - Fax:831-625-2298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD2738332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0813500001Medicare NSC