Provider Demographics
NPI:1508104084
Name:20/20 VISION CENTER INC
Entity Type:Organization
Organization Name:20/20 VISION CENTER INC
Other - Org Name:20/20 VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:TATUM
Authorized Official - Last Name:TRUDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-966-4565
Mailing Address - Street 1:1441 E KING RD
Mailing Address - Street 2:
Mailing Address - City:TOMAHAWK
Mailing Address - State:WI
Mailing Address - Zip Code:54487-2008
Mailing Address - Country:US
Mailing Address - Phone:715-966-4565
Mailing Address - Fax:
Practice Address - Street 1:1523 METRO DR
Practice Address - Street 2:
Practice Address - City:SCHOFIELD
Practice Address - State:WI
Practice Address - Zip Code:54476-2378
Practice Address - Country:US
Practice Address - Phone:715-355-8800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier