Organization
20 20 OPTICAL DISPENSATORY, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GUILHERME WILLIAM DWIN DO (DISPENSING OPTICIAN)
(954) 472-2422
Entity
Organization
Contact information
Practice address
1767 N UNIVERSITY DR, PLANTATION, FL 33322-4111
(954) 472-2422
Mailing address
1767 N UNIVERSITY DR, PLANTATION, FL 33322-4111
(954) 472-2422
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
1171
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GCG459EP
—
FL
Enumeration date
01/13/2011
Last updated
09/15/2011
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