Provider Demographics
NPI:1093885105
Name:20 20 EYECARE INC
Entity Type:Organization
Organization Name:20 20 EYECARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:JOSE
Authorized Official - Last Name:LYN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:205-755-3636
Mailing Address - Street 1:638 CLANTON MARKET PLACE
Mailing Address - Street 2:
Mailing Address - City:CLANTON
Mailing Address - State:AL
Mailing Address - Zip Code:35045-2246
Mailing Address - Country:US
Mailing Address - Phone:205-755-3636
Mailing Address - Fax:205-755-3777
Practice Address - Street 1:638 CLANTON MARKET PLACE
Practice Address - Street 2:
Practice Address - City:CLANTON
Practice Address - State:AL
Practice Address - Zip Code:35045-2246
Practice Address - Country:US
Practice Address - Phone:205-755-3636
Practice Address - Fax:205-755-3777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2010-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL6046610001Medicare NSC