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General NPI Number Information
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NPI Number | 1770275661
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Entity Type | Organization
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Legal Business Name | 20-20 EYECARE OF WINONA LLC
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Dates
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Enumeration Date | 05/22/2023
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Last Update Date | 05/22/2023
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Provider Practice Location Address
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Address Line | 111 N FRONT ST
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City | WINONA
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State | MS
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Zip | 38967-2219
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Country | US
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Telephone | 662-845-4367
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Fax |
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Provider Business Mailing Address
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Address Line | 111 N FRONT ST
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City | WINONA
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State | MS
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Zip | 38967-2219
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Country | US
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Telephone | 662-845-4367
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Fax |
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | DR. JAMES MICHAEL PEGG
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Credential | OD
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Telephone | 662-845-4367
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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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