Provider Demographics
NPI:1588938674
Name:2020 FAMILY EYECARE PLLC
Entity type:Organization
Organization Name:2020 FAMILY EYECARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CACHE
Authorized Official - Middle Name:MCKELL
Authorized Official - Last Name:CRAWFORD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:661-331-6011
Mailing Address - Street 1:301 S 4TH AVE
Mailing Address - Street 2:#C-2
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-6462
Mailing Address - Country:US
Mailing Address - Phone:208-637-0841
Mailing Address - Fax:
Practice Address - Street 1:301 S 4TH AVE
Practice Address - Street 2:#C-2
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-6462
Practice Address - Country:US
Practice Address - Phone:208-637-0841
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP-100247152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDODP-100247OtherLICENSE NUMBER