Provider Demographics
NPI:1639589872
Name:SP SPECTACLES
Entity Type:Organization
Organization Name:SP SPECTACLES
Other - Org Name:SITE FOR SORE EYES
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:R
Authorized Official - Last Name:BEZVERKH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-347-1500
Mailing Address - Street 1:115 E 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-4012
Mailing Address - Country:US
Mailing Address - Phone:650-347-1500
Mailing Address - Fax:650-374-1023
Practice Address - Street 1:115 E 3RD AVE
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-4012
Practice Address - Country:US
Practice Address - Phone:650-347-1500
Practice Address - Fax:650-347-1023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-28
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA164571332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier