MEDICARE: 20-20VISION, LLC

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
2	156FX1800X	Optician

General Provider Information

NPI Number	:	1104176981
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	20-20VISION, LLC

Provider Business Mailing Address
First Line	:	1516 SUMMIT AVE
Second Line	:
City	:	UNION CITY
State	:	NJ
Zip	:	07087-1949
Country	:	US
Telephone Number	:	201-974-0401
Fax Number	:

Provider Business Practice Location Address
First Line	:	1516 SUMMIT AVE
Second Line	:
City	:	UNION CITY
State	:	NJ
Zip	:	07087-1949
Country	:	US
Telephone Number	:	201-974-0401
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NILAM SHAH
Credential	:	OPTICIAN
Telephone Number	:	201-974-0401

Provider Enumeration Date	:	09/19/2012
Last Update Date	:	09/19/2012

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