Provider Demographics
NPI:1861551632
Name:20 20 OPTOMETRY, INC.
Entity type:Organization
Organization Name:20 20 OPTOMETRY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:NA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:650-349-5733
Mailing Address - Street 1:115 W 25TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-2259
Mailing Address - Country:US
Mailing Address - Phone:650-349-5733
Mailing Address - Fax:650-349-5721
Practice Address - Street 1:115 W 25TH AVE
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-2259
Practice Address - Country:US
Practice Address - Phone:650-349-5733
Practice Address - Fax:650-349-5721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-08
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABP257AMedicare UPIN
CA5866410001Medicare NSC
CABP257BMedicare PIN
CASD0117090Medicare PIN
CABP257AMedicare PIN
CABP257BMedicare UPIN
CAU91271Medicare UPIN