Provider Demographics
NPI:1922350636
Name:20-20 VISION EXPRESS LLC
Entity Type:Organization
Organization Name:20-20 VISION EXPRESS LLC
Other - Org Name:20/20 VISION EXPRESS LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:H
Authorized Official - Last Name:LUND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-235-0280
Mailing Address - Street 1:1300 GATEWAY DR S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-3509
Mailing Address - Country:US
Mailing Address - Phone:701-235-0280
Mailing Address - Fax:701-235-3326
Practice Address - Street 1:1300 GATEWAY DR S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-3509
Practice Address - Country:US
Practice Address - Phone:701-235-0280
Practice Address - Fax:701-235-3326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-04
Last Update Date:2016-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND520261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center