Provider Demographics
NPI:1790109122
Name:SPECTACLE LTD
Entity Type:Organization
Organization Name:SPECTACLE LTD
Other - Org Name:SPECTACLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VANESSA
Authorized Official - Middle Name:KOJIMA
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:702-523-4860
Mailing Address - Street 1:9410 W SAHARA AVE
Mailing Address - Street 2:STE. 110
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-7090
Mailing Address - Country:US
Mailing Address - Phone:702-912-0460
Mailing Address - Fax:702-912-0461
Practice Address - Street 1:9410 W SAHARA AVE
Practice Address - Street 2:STE. 110
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-7090
Practice Address - Country:US
Practice Address - Phone:702-912-0460
Practice Address - Fax:702-912-0461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV403152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty