Provider Demographics
NPI:1134292915
Name:20/20 EYECARE CENTERS INC PS
Entity Type:Organization
Organization Name:20/20 EYECARE CENTERS INC PS
Other - Org Name:EYELAND OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:M
Authorized Official - Last Name:WILLEMS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:206-463-2020
Mailing Address - Street 1:PO BOX 706
Mailing Address - Street 2:
Mailing Address - City:VASHON
Mailing Address - State:WA
Mailing Address - Zip Code:98070-5204
Mailing Address - Country:US
Mailing Address - Phone:206-463-2020
Mailing Address - Fax:206-463-2043
Practice Address - Street 1:17609 VASHON HWY SW
Practice Address - Street 2:
Practice Address - City:VASHON
Practice Address - State:WA
Practice Address - Zip Code:98070-5204
Practice Address - Country:US
Practice Address - Phone:206-463-2020
Practice Address - Fax:206-463-2049
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2008-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2024420Medicaid
WA2024420Medicaid
WAGAB20231Medicare PIN