Provider Demographics
NPI:1386949279
Name:BEYOND 20/20
Entity type:Organization
Organization Name:BEYOND 20/20
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:RITA
Authorized Official - Middle Name:L
Authorized Official - Last Name:VAN SCYOC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-462-6601
Mailing Address - Street 1:1451 JASON RD
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:IN
Mailing Address - Zip Code:46140-1039
Mailing Address - Country:US
Mailing Address - Phone:317-462-6601
Mailing Address - Fax:317-462-6625
Practice Address - Street 1:1451 JASON RD
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-1039
Practice Address - Country:US
Practice Address - Phone:317-462-6601
Practice Address - Fax:317-462-6625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-24
Last Update Date:2011-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003533A152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty