Provider Demographics
NPI:1962516708
Name:20-20 SIGHT OF FORNEY P A
Entity type:Organization
Organization Name:20-20 SIGHT OF FORNEY P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:D
Authorized Official - Last Name:TARRANT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:972-522-2020
Mailing Address - Street 1:104 E. US HWY 80
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-8663
Mailing Address - Country:US
Mailing Address - Phone:972-522-2020
Mailing Address - Fax:972-552-1701
Practice Address - Street 1:104 E. US HWY 80
Practice Address - Street 2:SUITE 100
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-8663
Practice Address - Country:US
Practice Address - Phone:972-552-2020
Practice Address - Fax:972-552-1701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-18
Last Update Date:2011-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX196294601Medicaid
TX00X159Medicare PIN