Healthcare Provider Details

I. General information

NPI: 1528242047
Provider Name (Legal Business Name): 20 20 EYE CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2007
Last Update Date: 01/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 OLD HICKORY RD
GRENADA MS
38901-2727
US

IV. Provider business mailing address

600 OLD HICKORY RD
GRENADA MS
38901-2727
US

V. Phone/Fax

Practice location:
  • Phone: 662-226-7010
  • Fax: 662-227-1177
Mailing address:
  • Phone: 662-226-7010
  • Fax: 662-227-1177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number504
License Number StateMS

VIII. Authorized Official

Name: DR. CARL MARASCALCO
Title or Position: OWNER
Credential: OD
Phone: 662-226-7010