Provider Demographics
NPI:1881776698
Name:20/20 EYE WORKS, INC.
Entity type:Organization
Organization Name:20/20 EYE WORKS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEON
Authorized Official - Middle Name:
Authorized Official - Last Name:CEFALU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-630-9192
Mailing Address - Street 1:3505 PEMBERTON SQUARE BLVD
Mailing Address - Street 2:SUITE 45
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39180-5537
Mailing Address - Country:US
Mailing Address - Phone:601-630-9192
Mailing Address - Fax:601-630-8250
Practice Address - Street 1:3505 PEMBERTON SQUARE BLVD
Practice Address - Street 2:SUITE 45
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39180-5537
Practice Address - Country:US
Practice Address - Phone:601-630-9192
Practice Address - Fax:601-630-8250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS5800020001Medicare NSC