Provider Demographics
NPI:1922279777
Name:SPECTACULAR VISION SERVICES
Entity Type:Organization
Organization Name:SPECTACULAR VISION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:URSULA
Authorized Official - Middle Name:YVONNE
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-360-2949
Mailing Address - Street 1:3433 BUCKHORN DR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-2983
Mailing Address - Country:US
Mailing Address - Phone:405-360-2949
Mailing Address - Fax:405-360-8650
Practice Address - Street 1:3433 BUCKHORN DR
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-2983
Practice Address - Country:US
Practice Address - Phone:405-360-2949
Practice Address - Fax:405-360-8650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2008-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier