MEDICARE: TWENTY20 PROFESSIONAL PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1487272308
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TWENTY20 PROFESSIONAL PLLC

Provider Business Mailing Address
First Line	:	105 E PARKWOOD AVE STE 107
Second Line	:
City	:	FRIENDSWOOD
State	:	TX
Zip	:	77546-5727
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	18333 EGRET BAY BLVD STE 101
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-3200
Country	:	US
Telephone Number	:	281-488-5169
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. REAGAN RATCLIFF
Credential	:	OD
Telephone Number	:	281-648-1910

Provider Enumeration Date	:	07/07/2020
Last Update Date	:	08/14/2020

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