Provider Demographics
NPI:1154648103
Name:4247BIFOCAL LLC
Entity Type:Organization
Organization Name:4247BIFOCAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:HAVENS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:614-889-7755
Mailing Address - Street 1:6301 SAWMILL RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-1471
Mailing Address - Country:US
Mailing Address - Phone:614-889-7755
Mailing Address - Fax:614-889-7809
Practice Address - Street 1:6301 SAWMILL RD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-1471
Practice Address - Country:US
Practice Address - Phone:614-889-7755
Practice Address - Fax:614-889-7809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-30
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH4839152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty