Provider Demographics
NPI:1679821086
Name:BEYOND VTC 2020 PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:BEYOND VTC 2020 PROFESSIONAL CORPORATION
Other - Org Name:BEYOND 20/20 VISION TRAINING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRTI
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:732-307-7933
Mailing Address - Street 1:579 CRANBURY RD
Mailing Address - Street 2:SUITE I
Mailing Address - City:EAST BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08816-5405
Mailing Address - Country:US
Mailing Address - Phone:732-307-7933
Mailing Address - Fax:732-307-7934
Practice Address - Street 1:579 CRANBURY RD
Practice Address - Street 2:SUITE I
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-5405
Practice Address - Country:US
Practice Address - Phone:732-307-7933
Practice Address - Fax:732-307-7934
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-16
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ248165Medicare PIN
NJ229512Medicare PIN