Provider Demographics
NPI:1972829208
Name:SPEDALE OPTICS LLC
Entity Type:Organization
Organization Name:SPEDALE OPTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:ULRICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-636-6464
Mailing Address - Street 1:14165 JAMES RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:ROGERS
Mailing Address - State:MN
Mailing Address - Zip Code:55374-9317
Mailing Address - Country:US
Mailing Address - Phone:763-515-6065
Mailing Address - Fax:
Practice Address - Street 1:14165 JAMES RD
Practice Address - Street 2:SUITE 106
Practice Address - City:ROGERS
Practice Address - State:MN
Practice Address - Zip Code:55374-9317
Practice Address - Country:US
Practice Address - Phone:763-515-6065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty