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NPI Code Detail

MEDICARE: 20 20 EYECARE INC

MEDICARE: 20 20 EYECARE INC
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
1152W00000XOptometrist

General Provider Information

NPI Number : 1093885105
Entity Type Code : Organization
Provider Name (Legal Business Name) : 20 20 EYECARE INC
Provider Business Mailing Address
First Line : 638 CLANTON MARKET PLACE
Second Line :
City : CLANTON
State : AL
Zip : 35045-2246
Country : US
Telephone Number : 205-755-3636
Fax Number : 205-755-3777
Provider Business Practice Location Address
First Line : 638 CLANTON MARKET PLACE
Second Line :
City : CLANTON
State : AL
Zip : 35045-2246
Country : US
Telephone Number : 205-755-3636
Fax Number : 205-755-3777
Authorized Official
Title or Position : OWNER
Name : DR. MAURICE JOSE LYN
Credential : O.D.
Telephone Number : 205-755-3636
Provider Enumeration Date : 11/08/2006
Last Update Date : 09/10/2010

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