| 20/20 Vision Express Llc | |
|
1300 Gateway Dr S Fargo ND 58103-3509 | |
| (701) 235-0280 | |
| (701) 235-3326 |
| Full Name | 20/20 Vision Express Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 1300 Gateway Dr S, Fargo, North Dakota |
| Authorized Official Name and Position | Jeff H Lund (MANAGER) |
| Authorized Official Contact | 7012350280 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| 20/20 Vision Express Llc 1300 Gateway Dr S Fargo ND 58103-3509 Ph: (701) 235-0280 | 20/20 Vision Express Llc 1300 Gateway Dr S Fargo ND 58103-3509 Ph: (701) 235-0280 |
| NPI Number | 1922350636 |
|---|---|
| Provider Enumeration Date | 10/04/2012 |
| Last Update Date | 04/22/2016 |
| Medicare PECOS PAC ID | 8022269430 |
|---|---|
| Medicare Enrollment ID | O20121231000319 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922350636 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 520 (North Dakota) | Primary |
| Provider Name | Adam J Motacek |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1568797124 PECOS PAC ID: 0244481034 Enrollment ID: I20121102000213 |
| Provider Name | Jordan D Muir |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1699125765 PECOS PAC ID: 3678854080 Enrollment ID: I20161223000386 |
| Provider Name | Aaron L Motacek |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1497378525 PECOS PAC ID: 2264859115 Enrollment ID: I20200824003437 |
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