Provider Demographics
NPI:1619131281
Name:20/20 EYECARE OF LONDON, LLC
Entity Type:Organization
Organization Name:20/20 EYECARE OF LONDON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TESHAWNA
Authorized Official - Middle Name:BARKER
Authorized Official - Last Name:SUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:606-878-7500
Mailing Address - Street 1:930 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-2521
Mailing Address - Country:US
Mailing Address - Phone:606-878-7500
Mailing Address - Fax:606-878-8005
Practice Address - Street 1:677 MEYERS BAKER RD
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-3006
Practice Address - Country:US
Practice Address - Phone:606-878-7500
Practice Address - Fax:606-878-8005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-14
Last Update Date:2022-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1541-DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100046760Medicaid
KY6126310001Medicare NSC
KY00719Medicare PIN