Provider Demographics
NPI:1013231943
Name:INFOCUS EYEWEAR
Entity Type:Organization
Organization Name:INFOCUS EYEWEAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANTONIO
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-378-2511
Mailing Address - Street 1:719 GREEN VALLEY RD
Mailing Address - Street 2:STE 303 B
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-7014
Mailing Address - Country:US
Mailing Address - Phone:336-235-2577
Mailing Address - Fax:336-235-2578
Practice Address - Street 1:719 GREEN VALLEY RD
Practice Address - Street 2:STE 303 B
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-7014
Practice Address - Country:US
Practice Address - Phone:336-235-2577
Practice Address - Fax:336-235-2578
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KOALA EYE CENTRE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-22
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200100470261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8913132Medicaid
NC2328003Medicare PIN
NCF85834Medicare UPIN