Provider Demographics
NPI:1053687384
Name:20/20 EYEWEAR INC.
Entity type:Organization
Organization Name:20/20 EYEWEAR INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:BLAIR
Authorized Official - Last Name:FOWLER
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:843-248-2020
Mailing Address - Street 1:1315 HIGHWAY 501 BUSINESS STE A
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:SC
Mailing Address - Zip Code:29526-9549
Mailing Address - Country:US
Mailing Address - Phone:843-248-2020
Mailing Address - Fax:843-347-2024
Practice Address - Street 1:1315 HIGHWAY 501 BUSINESS STE A
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:SC
Practice Address - Zip Code:29526-9549
Practice Address - Country:US
Practice Address - Phone:843-248-2020
Practice Address - Fax:843-347-2024
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:20/20EYEWEAR INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC713332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier