20-20 VISION CLINIC, LLP — NPI 1104957257 (Licensed & Credentialed Eye and Vision Service Providers

CMS-1500 Box 24J / 33a • NPI

1104957257

Type 2 Organization (Box 32a/33a)

HIPAA NUCC Taxonomy • CMS Code

152W00000X (CMS 41)

Licensed & Credentialed Eye and Vision Service Providers — Optometrist

Box 32 Service Location & ZIP+4

819 IRA E WOODS AVE, GRAPEVINE, TX, 76051-4012

✓ 9-Digit EDI 837 ZIP+4 (76051-4012)

Practice Phone & Referral Fax

(817) 488-4893

Fax: (817) 488-5939

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1104957257 (20-20 VISION CLINIC, LLP) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

Institutional Type-2 NPI facilities enroll via CMS-855A institutional provider agreements rather than individual Order & Referring PECOS.

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1104957257` (NPI-2 Organization / Facility)
Provider / Legal Name	20-20 VISION CLINIC, LLP
Plain-English Specialty	Licensed & Credentialed Eye and Vision Service Providers — Optometrist NUCC Code: `152W00000X` (Optometrist)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	819 IRA E WOODS AVE, GRAPEVINE, TX, 76051-4012
Practice Telephone / Fax	Tel: (817) 488-4893 \| Fax: (817) 488-5939
Administrative Mailing Address	819 IRA E WOODS AVE, GRAPEVINE, TX, 76051-4012
Enumeration & Last Sync	Enumerated: 2007-03-08 \| CMS Record Updated: 2016-07-07
Authorized Official	JERRY LATHAM (Managing Partner)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

819 IRA E WOODS AVE, GRAPEVINE, TX, 76051-4012

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Plain-English Taxonomy & CMS Crosswalk (152W00000X)

What Does Taxonomy Code 152W00000X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 152W00000X translates to:
"Licensed & Credentialed Eye and Vision Service Providers — Optometrist"

CMS-1500 Medicare Specialty Crosswalk: CMS Code 41 (Optometry)
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Optometrist for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (20-20 VISION CLINIC, LLP)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`152W00000X` — Optometrist Plain English: Licensed & Credentialed Eye and Vision Service Providers — Optometrist	State: TX \| License: `Verified` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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20-20 VISION CLINIC, LLP (NPI #1104957257)