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General NPI Number Information
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NPI Number | 1053687384
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Entity Type | Organization
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Legal Business Name | 20/20 EYEWEAR INC.
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Dates
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Enumeration Date | 03/30/2012
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Last Update Date | 03/30/2012
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Provider Practice Location Address
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Address Line | 1315 HIGHWAY 501 BUSINESS STE A
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City | CONWAY
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State | SC
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Zip | 29526-9549
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Country | US
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Telephone | 843-248-2020
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Fax | 843-347-2024
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Provider Business Mailing Address
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Address Line | 1315 HIGHWAY 501 BUSINESS STE A
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City | CONWAY
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State | SC
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Zip | 29526-9549
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Country | US
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Telephone | 843-248-2020
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Fax | 843-347-2024
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Authorized Official
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Title or Position | OWNER
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Name | MR. JOHN BLAIR FOWLER
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Credential | L.D.O
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Telephone | 843-248-2020
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 713
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License Number State | SC
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