Provider Demographics
NPI:1952310492
Name:2020 VISION CENTER, PA
Entity Type:Organization
Organization Name:2020 VISION CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:662-350-3676
Mailing Address - Street 1:499 GLOSTER CREEK VILLAGE
Mailing Address - Street 2:SUITE F3
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-4631
Mailing Address - Country:US
Mailing Address - Phone:662-350-3676
Mailing Address - Fax:662-269-2601
Practice Address - Street 1:499 GLOSTER CREEK VILLAGE
Practice Address - Street 2:SUITE F3
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4631
Practice Address - Country:US
Practice Address - Phone:662-350-3676
Practice Address - Fax:662-269-2601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2016-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS730152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty