MEDICARE: ENVISION 20-20 ASSOCIATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	6490T	TX

General Provider Information

NPI Number	:	1023227667
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ENVISION 20-20 ASSOCIATION

Provider Business Mailing Address
First Line	:	1632 LOMAR DR
Second Line	:
City	:	CARROLLTON
State	:	TX
Zip	:	75007-1475
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1521 COCKRELL HILL RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75211-1315
Country	:	US
Telephone Number	:	214-337-0530
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	VU LAM
Credential	:
Telephone Number	:	214-337-0530

Provider Enumeration Date	:	05/21/2007
Last Update Date	:	08/22/2020

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Directions to “ENVISION 20-20 ASSOCIATION ” Practice Location

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