Provider Demographics
NPI:1407909658
Name:20 20 EYE SPECIALISTS PC
Entity Type:Organization
Organization Name:20 20 EYE SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-885-0116
Mailing Address - Street 1:PO BOX 366
Mailing Address - Street 2:
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46402-0366
Mailing Address - Country:US
Mailing Address - Phone:219-885-0116
Mailing Address - Fax:219-881-0522
Practice Address - Street 1:2318 W 5TH AVE
Practice Address - Street 2:
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46404-1331
Practice Address - Country:US
Practice Address - Phone:219-885-0116
Practice Address - Fax:219-881-0522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01039743A207W00000X
IL036086767207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200043220Medicaid
90001013OtherBCBS OF IL
IN000000219285OtherANTHEM BCBS
IL036097526Medicaid
IN0774000001Medicare NSC
INCA5832Medicare PIN
IL036097526Medicaid