Grand Spectacle INC
NPI #1003935867 in Saint Paul, Minnesota
Provider Information
- NPI Number
- 1003935867
- Entity Type
- Organization
- Organization Name
- Grand Spectacle INC
- Primary Specialty
- Technician/Technologist - Optician
- Enumeration Date
- Mar 29, 2007
- Last Updated
- Aug 22, 2020
Practice Location
- Address
- 764 GRAND AVE
- City
- Saint Paul
- State
- Minnesota
- ZIP Code
- 55105-3306
- Phone
- (651) 227-8198
Authorized Official
- Name
- MR. MATTHEW MCDONOUGH, ABOM, NCLE
- Title
- CERTIFIED OPTICIAN
- Phone
- (651) 227-8198
Specialties & Taxonomy Codes
| Specialty |
|---|
| Technician/Technologist - Optician — Optician |
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