Provider Demographics
NPI:1932629987
Name:20/20 ICARE AND IWEAR, PLLC
Entity type:Organization
Organization Name:20/20 ICARE AND IWEAR, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:LONG
Authorized Official - Middle Name:
Authorized Official - Last Name:DO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:817-262-2145
Mailing Address - Street 1:1001 RHONE LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-1449
Mailing Address - Country:US
Mailing Address - Phone:817-262-2145
Mailing Address - Fax:
Practice Address - Street 1:3510 S STATE HWY 161
Practice Address - Street 2:SUITE 110
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75052
Practice Address - Country:US
Practice Address - Phone:972-264-7200
Practice Address - Fax:972-264-7220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-21
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8143TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty