Provider Demographics
NPI:1821482605
Name:VISION FOR 2020 OPTICAL
Entity Type:Organization
Organization Name:VISION FOR 2020 OPTICAL
Other - Org Name:VISION AT 2020 OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIOS
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:305-556-8928
Mailing Address - Street 1:1734 W 68TH ST
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-4437
Mailing Address - Country:US
Mailing Address - Phone:305-556-8928
Mailing Address - Fax:305-828-8667
Practice Address - Street 1:1734 W 68TH ST
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-4437
Practice Address - Country:US
Practice Address - Phone:305-556-8928
Practice Address - Fax:305-828-8667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-19
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO 6102156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty