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General NPI Number Information
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NPI Number | 1124048053
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Entity Type | Organization
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Legal Business Name | 20/20 VISION CENTER INC
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Dates
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Enumeration Date | 07/21/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 217 ST JAMES AVE STE A5
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City | GOOSE CREEK
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State | SC
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Zip | 29445
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Country | US
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Telephone | 843-797-5711
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Fax | 843-797-5712
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Provider Business Mailing Address
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Address Line | 217 ST JAMES AVE STE A5
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City | GOOSE CREEK
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State | SC
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Zip | 29445
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Country | US
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Telephone | 843-797-5711
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Fax | 843-797-5712
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Authorized Official
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Title or Position | OWNER
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Name | MRS. VICKI W CHAMBERLAIN
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Credential | OPTICIAN
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Telephone | 843-797-5711
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | 535
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License Number State | SC
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