Provider Demographics
NPI:1679958847
Name:20-20 EXPRESS--HOUSTON LLC
Entity Type:Organization
Organization Name:20-20 EXPRESS--HOUSTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF MANAGED CARE
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:PITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-997-1583
Mailing Address - Street 1:14079 FM 2920
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77377
Mailing Address - Country:US
Mailing Address - Phone:346-701-4029
Mailing Address - Fax:281-516-7240
Practice Address - Street 1:14079 FM 2920
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77377
Practice Address - Country:US
Practice Address - Phone:346-701-4029
Practice Address - Fax:281-516-7240
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:20-20 EXPRESS--HOUSTON LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-07-29
Last Update Date:2015-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier