Basic Information
| Provider Information | |||||||||
| NPI: | 1184803421 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | 20/20 VISION CARE INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1313 S 10TH ST | ||||||||
| Address2: | |||||||||
| City: | MCALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785015023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9566302020 | ||||||||
| FaxNumber: | 9566302060 | ||||||||
| Practice Location | |||||||||
| Address1: | 1313 S 10TH ST | ||||||||
| Address2: | |||||||||
| City: | MCALLEN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785015023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9566302020 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2007 | ||||||||
| LastUpdateDate: | 05/22/2008 | ||||||||
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| AuthorizedOfficialLastName: | FARIAS | ||||||||
| AuthorizedOfficialFirstName: | FRED | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER/PROVIDER | ||||||||
| AuthorizedOfficialTelephone: | 9566302020 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | O.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 3877 | TX | Y | 193400000X SINGLE SPECIALTY GROUP | Eye and Vision Services Providers | Optometrist |
ID Information
| ID | Type | State | Issuer | Description | 00E71M | 01 | TX | BCBS | OTHER | 110211 | 01 | TX | EYEMED | OTHER | 32713 | 01 | TX | OPTICARE | OTHER | 090753001 | 01 | TX | MEDICARE RAIL ROAD | OTHER | 093372302 | 05 | TX | MEDICAID |