Provider Demographics
NPI:1497949002
Name:SPECTICCA INC
Entity Type:Organization
Organization Name:SPECTICCA INC
Other - Org Name:SPECTICCA OPTICAL BOUTIQUE
Other - Org Type:Other Name
Authorized Official - Title/Position:OPTICIAN/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CLAUDE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUGUET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-549-5700
Mailing Address - Street 1:319 N HIGGINS AVE
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4537
Mailing Address - Country:US
Mailing Address - Phone:406-549-5700
Mailing Address - Fax:
Practice Address - Street 1:319 N HIGGINS AVE
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4537
Practice Address - Country:US
Practice Address - Phone:406-549-5700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-28
Last Update Date:2011-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTBL01-9385332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT6073810001Medicare NSC