Provider Demographics
NPI:1346383577
Name:NORTHSHORE SPECTACLES LLC
Entity Type:Organization
Organization Name:NORTHSHORE SPECTACLES LLC
Other - Org Name:SPECTACLES EYEWEAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MONS
Authorized Official - Suffix:
Authorized Official - Credentials:ABOC
Authorized Official - Phone:985-875-9171
Mailing Address - Street 1:69160 HIGHWAY 59
Mailing Address - Street 2:SUITE 2
Mailing Address - City:MANDEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70471-7781
Mailing Address - Country:US
Mailing Address - Phone:985-875-9171
Mailing Address - Fax:985-875-0115
Practice Address - Street 1:69160 HIGHWAY 59
Practice Address - Street 2:SUITE 2
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70471-7781
Practice Address - Country:US
Practice Address - Phone:985-875-9171
Practice Address - Fax:985-875-0115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty