Provider Demographics
NPI:1700935152
Name:20-20 LAB INC.
Entity Type:Organization
Organization Name:20-20 LAB INC.
Other - Org Name:20-20 OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK POLLINA
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:POLLINA
Authorized Official - Suffix:
Authorized Official - Credentials:OPHTHALCIM DISPENSER
Authorized Official - Phone:631-399-2020
Mailing Address - Street 1:800 MONTAUK HWY
Mailing Address - Street 2:SUITE 13
Mailing Address - City:SHIRLEY
Mailing Address - State:NY
Mailing Address - Zip Code:11967-2128
Mailing Address - Country:US
Mailing Address - Phone:631-399-0004
Mailing Address - Fax:
Practice Address - Street 1:800 MONTAUK HWY
Practice Address - Street 2:SUITE 13
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967-2128
Practice Address - Country:US
Practice Address - Phone:631-399-0004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005336-1332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0074690Medicaid
NY0606250001Medicare NSC