Healthcare Provider Details

I. General information

NPI: 1619207784
Provider Name (Legal Business Name): TWENTY-TWENTY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2010
Last Update Date: 01/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 DANADA SQ W
WHEATON IL
60189-2041
US

IV. Provider business mailing address

160 DANADA SQ W
WHEATON IL
60189-2041
US

V. Phone/Fax

Practice location:
  • Phone: 630-752-0595
  • Fax: 630-752-0145
Mailing address:
  • Phone: 630-752-0595
  • Fax: 630-752-0145

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: RICHARD MITAL
Title or Position: PRESIDENT
Credential: ABOC
Phone: 630-752-0595