Provider Demographics
NPI:1942754700
Name:2020 EYEDR
Entity Type:Organization
Organization Name:2020 EYEDR
Other - Org Name:SOUTHLAKE EYES NOW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MANOJ
Authorized Official - Middle Name:
Authorized Official - Last Name:ABRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:630-452-6290
Mailing Address - Street 1:1505 STONE DR
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-1147
Mailing Address - Country:US
Mailing Address - Phone:630-452-6290
Mailing Address - Fax:888-619-2009
Practice Address - Street 1:1251 E SOUTHLAKE BLVD
Practice Address - Street 2:SUITE 331
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6478
Practice Address - Country:US
Practice Address - Phone:630-452-6290
Practice Address - Fax:888-619-2009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-10
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8563152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty