Provider Demographics
NPI:1043924004
Name:TWENTY20 VISION CENTER LLC
Entity Type:Organization
Organization Name:TWENTY20 VISION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:DR
Authorized Official - First Name:SAHAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ELTALLA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:954-805-1443
Mailing Address - Street 1:4423 SW 176TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33029-5268
Mailing Address - Country:US
Mailing Address - Phone:954-805-1443
Mailing Address - Fax:
Practice Address - Street 1:5601 NW 183RD ST
Practice Address - Street 2:
Practice Address - City:MIAMI GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33055-2305
Practice Address - Country:US
Practice Address - Phone:305-760-7008
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-12
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty