Provider Demographics
NPI:1710924949
Name:20-20 EYECARE PSC
Entity Type:Organization
Organization Name:20-20 EYECARE PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:502-955-2020
Mailing Address - Street 1:5855 RELIABLE PKWY
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60686-0086
Mailing Address - Country:US
Mailing Address - Phone:502-636-5766
Mailing Address - Fax:502-736-4490
Practice Address - Street 1:215 CENTRAL AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40208-1449
Practice Address - Country:US
Practice Address - Phone:502-636-5766
Practice Address - Fax:502-736-4490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77904159Medicaid
KY9590Medicare PIN
KY5375220006Medicare NSC