20-20 VISION PLACE INC — NPI 1639445703 (Licensed & Credentialed Eye and Vision Service Providers

CMS-1500 Box 24J / 33a • NPI

1639445703

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

12801 W SUNRISE BLVD, STE 931, SUNRISE, FL, 33323-4020

✓ 9-Digit EDI 837 ZIP+4 (33323-4020)

Practice Phone & Referral Fax

(954) 851-9949

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1639445703 (20-20 VISION PLACE INC) 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	`1639445703` (NPI-2 Organization / Facility)
Provider / Legal Name	20-20 VISION PLACE INC
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	12801 W SUNRISE BLVD, STE 931, SUNRISE, FL, 33323-4020
Practice Telephone / Fax	Tel: (954) 851-9949
Administrative Mailing Address	135 WESTON RD, WESTON, FL, 33326-1111
Enumeration & Last Sync	Enumerated: 2012-03-22 \| CMS Record Updated: 2023-11-20
Authorized Official	RALPH BOURJOLLY (OWNER)

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

12801 W SUNRISE BLVD, STE 931, SUNRISE, FL, 33323-4020

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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 PLACE INC)

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: FL \| License: `OPC2667` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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20-20 VISION PLACE INC (NPI #1639445703)