Provider Demographics
NPI:1033274758
Name:20-20 VISION CARE INC
Entity Type:Organization
Organization Name:20-20 VISION CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:J
Authorized Official - Middle Name:MINOR
Authorized Official - Last Name:PACE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:601-939-3753
Mailing Address - Street 1:100 AIRPORT RD S
Mailing Address - Street 2:
Mailing Address - City:PEARL
Mailing Address - State:MS
Mailing Address - Zip Code:39208-6654
Mailing Address - Country:US
Mailing Address - Phone:601-939-3753
Mailing Address - Fax:601-939-6586
Practice Address - Street 1:100 AIRPORT RD S
Practice Address - Street 2:
Practice Address - City:PEARL
Practice Address - State:MS
Practice Address - Zip Code:39208-6654
Practice Address - Country:US
Practice Address - Phone:601-939-3753
Practice Address - Fax:601-939-6586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09015539Medicaid
MS09015539Medicaid
MSC02605Medicare PIN