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General NPI Number Information
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NPI Number | 1093975021
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Entity Type | Organization
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Legal Business Name | 20/20 OPTICAL LLC
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Dates
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Enumeration Date | 06/12/2008
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Last Update Date | 12/18/2008
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Provider Practice Location Address
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Address Line | 7268 JARNIGAN RD SUITE 304
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City | CHATTANOOGA
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State | TN
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Zip | 37421-3096
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Country | US
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Telephone | 423-899-3930
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Fax | 423-899-1590
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Provider Business Mailing Address
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Address Line | 7268 JARNIGAN RD SUITE 304
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City | CHATTANOOGA
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State | TN
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Zip | 37421-3096
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Country | US
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Telephone | 423-899-3930
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Fax | 423-899-1590
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Authorized Official
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Title or Position | MANAGER
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Name | MR. GENE A WILLIFORD
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Credential | D.PO.
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Telephone | 423-899-3930
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number | TN0291
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License Number State | TN
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