MEDICARE: 20-20 VISIONS LLC

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	WI2028	WI

General Provider Information

NPI Number	:	1821139932
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	20-20 VISIONS LLC

Provider Business Mailing Address
First Line	:	100 CARR ROAD
Second Line	:	PO BOX 600
City	:	PLYMOUTH
State	:	WI
Zip	:	53073-0600
Country	:	US
Telephone Number	:	920-893-3937
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 CARR ROAD
Second Line	:
City	:	PLYMOUTH
State	:	WI
Zip	:	53073-0600
Country	:	US
Telephone Number	:	920-893-3937
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. SHARON R ROBERTS
Credential	:	O.D.
Telephone Number	:	920-893-3937

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	06/25/2008

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