Provider Demographics
NPI:1588787105
Name:2020 EYE CARE CENTER
Entity type:Organization
Organization Name:2020 EYE CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:LASSITER
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:704-664-1124
Mailing Address - Street 1:PO BOX 1524
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-1524
Mailing Address - Country:US
Mailing Address - Phone:704-664-1124
Mailing Address - Fax:
Practice Address - Street 1:322 E STATESVILLE AVE
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-2594
Practice Address - Country:US
Practice Address - Phone:704-664-1124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5671680001Medicare ID - Type Unspecified