Provider Demographics
NPI:1669816849
Name:20-20 SIGHT OF LAKEWOOD PA
Entity Type:Organization
Organization Name:20-20 SIGHT OF LAKEWOOD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:DON
Authorized Official - Last Name:TARRANT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:214-773-3457
Mailing Address - Street 1:1905 ABRAMS RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-3916
Mailing Address - Country:US
Mailing Address - Phone:214-821-2020
Mailing Address - Fax:214-821-2025
Practice Address - Street 1:1905 ABRAMS RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75214-3916
Practice Address - Country:US
Practice Address - Phone:214-821-2020
Practice Address - Fax:972-264-7220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-18
Last Update Date:2014-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
5597TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX038437201Medicaid
TX038435601Medicaid
TX216013701Medicaid
TX216013701Medicaid