MEDICARE: 20-20 OPTICAL INC

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	156FX1800X	Optician		MN
2	332H00000X	Eyewear Supplier

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	4C789TW	OTHER	MN	BLUE CROSS BLUE SHIELD MN
3	892886	OTHER	ND	ND VISION SERVICES
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	VMN000233	OTHER	AZ	AVESIS
7	1046788	OTHER		PREFERRED ONE
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

NPI Number	:	1619972734
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	20-20 OPTICAL INC

Provider Business Mailing Address
First Line	:	615 S MILL ST
Second Line	:	STE 2
City	:	FERGUS FALLS
State	:	MN
Zip	:	56537-2756
Country	:	US
Telephone Number	:	218-998-2020
Fax Number	:	218-998-2098

Provider Business Practice Location Address
First Line	:	615 S MILL ST
Second Line	:	STE 2
City	:	FERGUS FALLS
State	:	MN
Zip	:	56537-2756
Country	:	US
Telephone Number	:	218-998-2020
Fax Number	:	218-998-2098

Authorized Official
Title or Position	:	OWNER/MANAGER
Name	:	MR. DAVID G. GAUSTAD
Credential	:
Telephone Number	:	218-998-2020

Provider Enumeration Date	:	06/15/2005
Last Update Date	:	07/13/2009

2500 E 52ND ST N , CIGNA MEDICARE SERVICES
SIOUX FALLS, SD
57104-7106

Practice Phone: 605-373-0100
Practice Fax: