Provider Demographics
NPI:1851513188
Name:TWENTY-TWENTY VISION,INC.
Entity Type:Organization
Organization Name:TWENTY-TWENTY VISION,INC.
Other - Org Name:PEARLE VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:W
Authorized Official - Last Name:EAVES
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:781-826-8393
Mailing Address - Street 1:1422 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02339-1647
Mailing Address - Country:US
Mailing Address - Phone:781-826-8393
Mailing Address - Fax:781-826-8764
Practice Address - Street 1:1422 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:MA
Practice Address - Zip Code:02339-1647
Practice Address - Country:US
Practice Address - Phone:781-826-8393
Practice Address - Fax:781-826-8764
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2010-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA3123152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9742204Medicaid
MA9742204Medicaid