MEDICARE: 20/20 EXPRESS-DALLAS, 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	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1114318250
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	20/20 EXPRESS-DALLAS, LLC

Provider Business Mailing Address
First Line	:	13800 SENLAC DR
Second Line	:	SUITE 200
City	:	FARMERS BRANCH
State	:	TX
Zip	:	75234-8838
Country	:	US
Telephone Number	:	972-488-2016
Fax Number	:	469-206-5169

Provider Business Practice Location Address
First Line	:	13800 SENLAC DR
Second Line	:	SUITE 200
City	:	FARMERS BRANCH
State	:	TX
Zip	:	75234-8838
Country	:	US
Telephone Number	:	972-488-2016
Fax Number	:	469-206-5169

Authorized Official
Title or Position	:	DIRECTOR OF MANAGED CARE
Name	:	KAREN PITTMAN
Credential	:
Telephone Number	:	920-997-1583

Provider Enumeration Date	:	02/11/2015
Last Update Date	:	02/11/2015

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Directions to “20/20 EXPRESS-DALLAS, LLC ” Practice Location

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