Provider Demographics
NPI:1376783860
Name:20 20 OPTICAL
Entity Type:Organization
Organization Name:20 20 OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:AURA
Authorized Official - Middle Name:VIOLETA
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-679-1158
Mailing Address - Street 1:14721 PRAIRIE AVE
Mailing Address - Street 2:
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-1831
Mailing Address - Country:US
Mailing Address - Phone:310-679-1158
Mailing Address - Fax:310-679-0289
Practice Address - Street 1:14721 PRAIRIE AVE
Practice Address - Street 2:
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-1831
Practice Address - Country:US
Practice Address - Phone:310-678-1158
Practice Address - Fax:310-679-0289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8774302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization