Provider Demographics
NPI:1164805081
Name:20/20 IMAGE GLENDALE PLC
Entity Type:Organization
Organization Name:20/20 IMAGE GLENDALE PLC
Other - Org Name:20/20 IMAGE EYE CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DOCTOR OF OPTOMETRY
Authorized Official - Prefix:DR
Authorized Official - First Name:VASVI
Authorized Official - Middle Name:
Authorized Official - Last Name:BABU
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:480-287-5665
Mailing Address - Street 1:6666 W PEORIA AVE
Mailing Address - Street 2:SUITE 108-109
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-7014
Mailing Address - Country:US
Mailing Address - Phone:623-979-8876
Mailing Address - Fax:480-287-5666
Practice Address - Street 1:6666 W PEORIA AVE
Practice Address - Street 2:SUITE 108-109
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85302-7014
Practice Address - Country:US
Practice Address - Phone:623-979-8876
Practice Address - Fax:480-287-5666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-09
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty