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General NPI Number Information
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NPI Number | 1922350636
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Entity Type | Organization
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Legal Business Name | 20-20 VISION EXPRESS LLC
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Dates
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Enumeration Date | 10/04/2012
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Last Update Date | 04/22/2016
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Provider Practice Location Address
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Address Line | 1300 GATEWAY DR S
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City | FARGO
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State | ND
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Zip | 58103-3509
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Country | US
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Telephone | 701-235-0280
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Fax | 701-235-3326
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Provider Business Mailing Address
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Address Line | 1300 GATEWAY DR S
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City | FARGO
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State | ND
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Zip | 58103-3509
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Country | US
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Telephone | 701-235-0280
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Fax | 701-235-3326
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Authorized Official
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Title or Position | MANAGER
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Name | MR. JEFF H LUND
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Credential |
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Telephone | 701-235-0280
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 520
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License Number State | ND
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