Provider Demographics
NPI:1801445028
Name:ENVISION 2020 EYECARE, LLC
Entity type:Organization
Organization Name:ENVISION 2020 EYECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:F
Authorized Official - Last Name:HENDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:860-597-7456
Mailing Address - Street 1:380 WEST MAIN STREET
Mailing Address - Street 2:LENSCRAFTERS DOCTOR'S OFFICE
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001
Mailing Address - Country:US
Mailing Address - Phone:860-409-4565
Mailing Address - Fax:860-831-1023
Practice Address - Street 1:380 W MAIN ST
Practice Address - Street 2:LENSCRAFTERS DOCTOR'S OFFICE
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-3690
Practice Address - Country:US
Practice Address - Phone:860-409-4565
Practice Address - Fax:860-831-1023
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-10
Last Update Date:2019-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty