Provider Demographics
NPI:1700289584
Name:20-20 EXPRESS--HOUSTON LLC
Entity Type:Organization
Organization Name:20-20 EXPRESS--HOUSTON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF MANAGED CARE
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:PITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-997-1583
Mailing Address - Street 1:10223 BROADWAY ST
Mailing Address - Street 2:SUITE J
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7880
Mailing Address - Country:US
Mailing Address - Phone:713-436-1964
Mailing Address - Fax:972-277-3176
Practice Address - Street 1:10223 BROADWAY ST
Practice Address - Street 2:SUITE J
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-7880
Practice Address - Country:US
Practice Address - Phone:713-436-1964
Practice Address - Fax:972-277-3176
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:20-20 EXPRESS--HOUSTON LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-07
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier