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General NPI Number Information
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NPI Number | 1689974669
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Entity Type | Organization
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Legal Business Name | 20/20 OPTICAL DISPENSARY, INC.
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Dates
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Enumeration Date | 10/25/2010
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Last Update Date | 10/25/2010
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Provider Practice Location Address
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Address Line | 100 S MILITARY TRL STE 6
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City | DEERFIELD BEACH
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State | FL
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Zip | 33442-3031
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Country | US
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Telephone | 954-571-2022
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Fax | 954-571-2922
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Provider Business Mailing Address
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Address Line | 100 S MILITARY TRL STE 6
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City | DEERFIELD BEACH
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State | FL
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Zip | 33442-3031
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Country | US
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Telephone | 954-571-2022
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Fax | 954-571-2922
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Authorized Official
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Title or Position | OPTICIAN/ OWNER
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Name | MR. GUILHERME WILLIAM DWIN
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Credential | LDO
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Telephone | 954-571-2022
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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 | 1171
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License Number State | FL
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