Provider Demographics
NPI:1417220260
Name:SPECTACULAR EYECARE
Entity Type:Organization
Organization Name:SPECTACULAR EYECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:LEBLANC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:863-675-2015
Mailing Address - Street 1:415 W HICKPOCHEE AVE
Mailing Address - Street 2:
Mailing Address - City:LABELLE
Mailing Address - State:FL
Mailing Address - Zip Code:33935-4763
Mailing Address - Country:US
Mailing Address - Phone:863-675-2015
Mailing Address - Fax:863-675-2012
Practice Address - Street 1:415 W HICKPOCHEE AVE
Practice Address - Street 2:
Practice Address - City:LABELLE
Practice Address - State:FL
Practice Address - Zip Code:33935-4763
Practice Address - Country:US
Practice Address - Phone:863-675-2015
Practice Address - Fax:863-675-2012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-09
Last Update Date:2015-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 3670152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty