Provider Demographics
NPI:1689974669
Name:20/20 OPTICAL DISPENSARY, INC.
Entity Type:Organization
Organization Name:20/20 OPTICAL DISPENSARY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTICIAN/ OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:GUILHERME
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:DWIN
Authorized Official - Suffix:
Authorized Official - Credentials:LDO
Authorized Official - Phone:954-571-2022
Mailing Address - Street 1:100 S MILITARY TRL STE 6
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-3031
Mailing Address - Country:US
Mailing Address - Phone:954-571-2022
Mailing Address - Fax:954-571-2922
Practice Address - Street 1:100 S MILITARY TRL STE 6
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-3031
Practice Address - Country:US
Practice Address - Phone:954-571-2022
Practice Address - Fax:954-571-2922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1171332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier