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	:	1275934465
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	20-20 EXPRESS--DALLAS LLC

Provider Business Mailing Address
First Line	:	5225 BELT LINE RD
Second Line	:	STE 222 & 230
City	:	DALLAS
State	:	TX
Zip	:	75254-1462
Country	:	US
Telephone Number	:	972-789-9658
Fax Number	:	972-277-3176

Provider Business Practice Location Address
First Line	:	5225 BELT LINE RD
Second Line	:	STE 222 & 230
City	:	DALLAS
State	:	TX
Zip	:	75254-1462
Country	:	US
Telephone Number	:	972-789-9658
Fax Number	:	972-277-3176

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

Provider Enumeration Date	:	09/08/2014
Last Update Date	:	06/04/2015

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