Provider Demographics
NPI:1366275190
Name:BEYOND 2020 VISION SPECIALISTS EAST LAKE
Entity type:Organization
Organization Name:BEYOND 2020 VISION SPECIALISTS EAST LAKE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICKY
Authorized Official - Middle Name:
Authorized Official - Last Name:THAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:626-257-1249
Mailing Address - Street 1:4974 RIDGEMOOR BLVD
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-1744
Mailing Address - Country:US
Mailing Address - Phone:626-257-1249
Mailing Address - Fax:
Practice Address - Street 1:4974 RIDGEMOOR BLVD
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34685-1744
Practice Address - Country:US
Practice Address - Phone:626-257-1249
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty