Provider Demographics
NPI:1275619116
Name:FOCUS VISION CLINIC OPTOMETRY INC
Entity Type:Organization
Organization Name:FOCUS VISION CLINIC OPTOMETRY INC
Other - Org Name:FOCUS VISION OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:L
Authorized Official - Last Name:VANGUILDER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:951-845-4749
Mailing Address - Street 1:1668 E 2ND ST STE B
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-3168
Mailing Address - Country:US
Mailing Address - Phone:951-845-4749
Mailing Address - Fax:951-845-8625
Practice Address - Street 1:1668 E 2ND ST STE B
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-3168
Practice Address - Country:US
Practice Address - Phone:951-845-4749
Practice Address - Fax:951-845-8625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2019-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12335T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6164280001Medicare PIN
ZZZ04039ZMedicare PIN