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General NPI Number Information
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NPI Number | 1366275190
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Entity Type | Organization
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Legal Business Name | BEYOND 2020 VISION SPECIALISTS EAST LAKE
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Dates
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Enumeration Date | 08/26/2024
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Last Update Date | 08/18/2025
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Provider Practice Location Address
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Address Line | 4974 RIDGEMOOR BLVD
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City | PALM HARBOR
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State | FL
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Zip | 34685-1744
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Country | US
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Telephone | 727-242-8388
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Fax | 813-909-8388
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Provider Business Mailing Address
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Address Line | 4974 RIDGEMOOR BLVD
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City | PALM HARBOR
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State | FL
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Zip | 34685-1744
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Country | US
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Telephone | 727-242-8388
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL/PRESIDENT
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Name | DR. VICKY THAN
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Credential | OD
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Telephone | 727-242-8388
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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