Provider Demographics
NPI:1003055583
Name:FOCAL POINT EYEWEAR, INC.
Entity Type:Organization
Organization Name:FOCAL POINT EYEWEAR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:HANEELIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MAX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-283-5206
Mailing Address - Street 1:P.O. BOX 2481
Mailing Address - Street 2:
Mailing Address - City:TUBA CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86045-2481
Mailing Address - Country:US
Mailing Address - Phone:928-283-5206
Mailing Address - Fax:928-283-5733
Practice Address - Street 1:322 HIGHWAY 160
Practice Address - Street 2:SUITE #6
Practice Address - City:TUBA CITY
Practice Address - State:AZ
Practice Address - Zip Code:86045-2489
Practice Address - Country:US
Practice Address - Phone:928-283-5206
Practice Address - Fax:928-283-5733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-06
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ119596Medicaid