Provider Demographics
NPI:1376951293
Name:SPECTACLE LLC
Entity Type:Organization
Organization Name:SPECTACLE LLC
Other - Org Name:SPECTACLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARC
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHMITT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:503-719-5179
Mailing Address - Street 1:2250 NW LOVEJOY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3020
Mailing Address - Country:US
Mailing Address - Phone:503-719-5179
Mailing Address - Fax:971-302-6934
Practice Address - Street 1:2250 NW LOVEJOY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3020
Practice Address - Country:US
Practice Address - Phone:503-719-5179
Practice Address - Fax:971-302-6934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3369ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty