Provider Demographics
NPI:1881731016
Name:20/20 EXPRESS
Entity type:Organization
Organization Name:20/20 EXPRESS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:DRINKARD
Authorized Official - Suffix:
Authorized Official - Credentials:0D
Authorized Official - Phone:830-798-9484
Mailing Address - Street 1:2512 HIGHWAY 281N
Mailing Address - Street 2:
Mailing Address - City:MARBLE FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:78654
Mailing Address - Country:US
Mailing Address - Phone:830-798-9484
Mailing Address - Fax:830-798-9485
Practice Address - Street 1:2512 HIGHWAY 281N
Practice Address - Street 2:
Practice Address - City:MARBLE FALLS
Practice Address - State:TX
Practice Address - Zip Code:78654
Practice Address - Country:US
Practice Address - Phone:830-798-9484
Practice Address - Fax:830-798-9485
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3414T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX093416801Medicaid
TX093416801Medicaid