Provider Demographics
NPI:1164542353
Name:FOCUS OPTICAL, LLC
Entity Type:Organization
Organization Name:FOCUS OPTICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:TIM
Authorized Official - Middle Name:
Authorized Official - Last Name:STANDAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-453-3777
Mailing Address - Street 1:1987 MCCULLOCH BLVD N
Mailing Address - Street 2:SUITE #108
Mailing Address - City:LAKE HAVASU CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86403-5770
Mailing Address - Country:US
Mailing Address - Phone:928-453-3777
Mailing Address - Fax:928-453-3570
Practice Address - Street 1:1987 MCCULLOCH BLVD N
Practice Address - Street 2:SUITE #108
Practice Address - City:LAKE HAVASU CITY
Practice Address - State:AZ
Practice Address - Zip Code:86403-5770
Practice Address - Country:US
Practice Address - Phone:928-453-3777
Practice Address - Fax:928-453-3570
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ4970770001Medicare ID - Type Unspecified