Provider Demographics
NPI:1467527473
Name:20-20 OPTICAL
Entity Type:Organization
Organization Name:20-20 OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROY
Authorized Official - Middle Name:R
Authorized Official - Last Name:FERGUSON
Authorized Official - Suffix:
Authorized Official - Credentials:LDO, PHD
Authorized Official - Phone:865-453-2025
Mailing Address - Street 1:PO BOX 5170
Mailing Address - Street 2:
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37864-5170
Mailing Address - Country:US
Mailing Address - Phone:865-453-2025
Mailing Address - Fax:865-429-1240
Practice Address - Street 1:120 BRUCE ST
Practice Address - Street 2:
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-3558
Practice Address - Country:US
Practice Address - Phone:865-453-2025
Practice Address - Fax:865-429-1240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPO0000000400332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site