Provider Demographics
NPI:1760416408
Name:20-20 SIGHT, PA
Entity Type:Organization
Organization Name:20-20 SIGHT, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:TARRANT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:972-264-7200
Mailing Address - Street 1:4116 S CARRIER PKWY
Mailing Address - Street 2:STE 120
Mailing Address - City:GRAND PRAIRIE
Mailing Address - State:TX
Mailing Address - Zip Code:75052-3200
Mailing Address - Country:US
Mailing Address - Phone:972-264-7200
Mailing Address - Fax:972-264-7220
Practice Address - Street 1:4116 S CARRIER PKWY
Practice Address - Street 2:STE 120
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052-3200
Practice Address - Country:US
Practice Address - Phone:972-264-7200
Practice Address - Fax:972-264-7220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX019115701Medicaid
TX019115701Medicaid