Provider Demographics
NPI:1063616175
Name:BEYOND 20 20 PC
Entity type:Organization
Organization Name:BEYOND 20 20 PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROLAND
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:505-884-8722
Mailing Address - Street 1:6600 MENAUL BLVD NE
Mailing Address - Street 2:SUITE M5A
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-3449
Mailing Address - Country:US
Mailing Address - Phone:505-884-8722
Mailing Address - Fax:505-872-0405
Practice Address - Street 1:6600 MENAUL BLVD NE
Practice Address - Street 2:SUITE M5A
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-3449
Practice Address - Country:US
Practice Address - Phone:505-884-8722
Practice Address - Fax:505-872-0405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM557152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty