Provider Demographics
NPI:1871146415
Name:20 20 ICARE, PLLC
Entity type:Organization
Organization Name:20 20 ICARE, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
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 1:3007 E CENTRAL TEXAS EXPRESSWAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76543
Mailing Address - Country:US
Mailing Address - Phone:254-200-0711
Mailing Address - Fax:254-200-0778
Practice Address - Street 1:3007 E CENTRAL TEXAS EXPRESSWAY
Practice Address - Street 2:SUITE 101
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76543
Practice Address - Country:US
Practice Address - Phone:254-200-0711
Practice Address - Fax:254-200-0778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-23
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty