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General NPI Number Information
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NPI Number | 1821139932
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Entity Type | Organization
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Legal Business Name | 20-20 VISIONS LLC
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 06/25/2008
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Provider Practice Location Address
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Address Line | 100 CARR ROAD
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City | PLYMOUTH
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State | WI
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Zip | 53073-0600
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Country | US
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Telephone | 920-893-3937
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Fax |
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Provider Business Mailing Address
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Address Line | 100 CARR ROAD PO BOX 600
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City | PLYMOUTH
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State | WI
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Zip | 53073-0600
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Country | US
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Telephone | 920-893-3937
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SHARON R ROBERTS
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Credential | O.D.
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Telephone | 920-893-3937
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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 | WI2028
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License Number State | WI
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