Provider Demographics
NPI:1144578642
Name:20/20 OPTICAL CENTER, LLC
Entity Type:Organization
Organization Name:20/20 OPTICAL CENTER, LLC
Other - Org Name:BROWN'S EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO OWNER/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:ANANIA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:478-328-0900
Mailing Address - Street 1:1112 RUSSELL PKWY
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31088-5539
Mailing Address - Country:US
Mailing Address - Phone:478-328-0900
Mailing Address - Fax:478-328-2911
Practice Address - Street 1:1112 RUSSELL PKWY
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31088-5539
Practice Address - Country:US
Practice Address - Phone:478-328-0900
Practice Address - Fax:478-328-2911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-15
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002416152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA20241I7377Medicare PIN