Provider Demographics
NPI:1356438808
Name:SPECTACULAR EYE CARE LLC
Entity type:Organization
Organization Name:SPECTACULAR EYE CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HUBBELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:410-268-4393
Mailing Address - Street 1:509 S CHERRY GROVE AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-4244
Mailing Address - Country:US
Mailing Address - Phone:410-268-4393
Mailing Address - Fax:
Practice Address - Street 1:509 S. CHERRY GROVE AVE
Practice Address - Street 2:SUITE C
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-4244
Practice Address - Country:US
Practice Address - Phone:410-268-4393
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDTA1798152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty