Healthcare Provider Details

I. General information

NPI: 1811689961
Provider Name (Legal Business Name): 20-20 EYECARE OF BATESVILLE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2023
Last Update Date: 05/25/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 CRACKER BARRELL DR
BATESVILLE MS
38606-3031
US

IV. Provider business mailing address

150 CRACKER BARRELL DR
BATESVILLE MS
38606-3031
US

V. Phone/Fax

Practice location:
  • Phone: 662-270-8090
  • Fax: 662-480-8660
Mailing address:
  • Phone: 662-270-8090
  • Fax: 662-480-8660

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. CHRISTOPHER THOMAS WALLS
Title or Position: SOLE MEMBER
Credential: OD
Phone: 662-226-7010