Provider Demographics
NPI:1295243533
Name:2020 VISION- MARION LLC
Entity type:Organization
Organization Name:2020 VISION- MARION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:HERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:618-998-2020
Mailing Address - Street 1:2700 W DEYOUNG ST STE E
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:IL
Mailing Address - Zip Code:62959-4950
Mailing Address - Country:US
Mailing Address - Phone:618-998-2020
Mailing Address - Fax:
Practice Address - Street 1:2700 W DEYOUNG ST STE E
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:IL
Practice Address - Zip Code:62959-4943
Practice Address - Country:US
Practice Address - Phone:618-998-2020
Practice Address - Fax:618-998-9199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-22
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier