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General NPI Number Information
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NPI Number | 1609323849
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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 | 09/06/2016
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Last Update Date | 09/06/2016
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Provider Practice Location Address
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Address Line | 1302 NE HIGHWAY 99W
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City | MCMINNVILLE
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State | OR
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Zip | 97128-2723
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Country | US
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Telephone | 503-472-5665
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Fax |
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Provider Business Mailing Address
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Address Line | 8623 CHEVIOT HTS
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City | SAN ANTONIO
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State | TX
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Zip | 78254-2303
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LORI A BROWN
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Credential |
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Telephone | 210-861-1393
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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 |
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License Number State |
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