Healthcare Provider Details

I. General information

NPI: 1295866978
Provider Name (Legal Business Name): 20 20 VISION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 08/10/2023
Certification Date: 08/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 N DIXON RD
KOKOMO IN
46901-4154
US

IV. Provider business mailing address

104 N DIXON RD
KOKOMO IN
46901-4154
US

V. Phone/Fax

Practice location:
  • Phone: 765-459-3937
  • Fax: 765-459-4430
Mailing address:
  • Phone: 765-459-3937
  • Fax: 765-459-4430

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANGELA DUGGINS
Title or Position: OFFICE MANAGER
Credential:
Phone: 765-459-3937