Provider Demographics
NPI:1215161815
Name:20/20 VISION ASSOCIATES OPTOMETRY, INC.
Entity type:Organization
Organization Name:20/20 VISION ASSOCIATES OPTOMETRY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:EVERITT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:951-684-7822
Mailing Address - Street 1:7379 INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92504-4547
Mailing Address - Country:US
Mailing Address - Phone:951-684-7822
Mailing Address - Fax:951-977-8075
Practice Address - Street 1:7379 INDIANA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92504-4547
Practice Address - Country:US
Practice Address - Phone:951-684-7822
Practice Address - Fax:951-977-8075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-11
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13309T152W00000X
CA10316T152W00000X
CA5187T152W00000X
CA33508TLG152W00000X
152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACS117ZMedicare PIN
CASD0133090Medicare PIN
CACD249AMedicare PIN
CA6405470001Medicare NSC
CACS429ZMedicare PIN
CASD0051871Medicare PIN
CASD0103161Medicare PIN