Provider Demographics
NPI:1134303068
Name:BEYOND 20/20
Entity Type:Organization
Organization Name:BEYOND 20/20
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACEE
Authorized Official - Middle Name:R
Authorized Official - Last Name:COTTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:307-775-0800
Mailing Address - Street 1:1401 AIRPORT PKWY
Mailing Address - Street 2:SUITE 120
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82001-1518
Mailing Address - Country:US
Mailing Address - Phone:307-775-0800
Mailing Address - Fax:307-775-0808
Practice Address - Street 1:1401 AIRPORT PKWY
Practice Address - Street 2:SUITE 120
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82001-1518
Practice Address - Country:US
Practice Address - Phone:307-775-0800
Practice Address - Fax:307-775-0808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-27
Last Update Date:2007-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY266T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY9284Medicare PIN