Provider Demographics
NPI:1447420765
Name:IN FOCUS OPTICAL
Entity Type:Organization
Organization Name:IN FOCUS OPTICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTICIAN
Authorized Official - Prefix:MS
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:R
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:ABOC
Authorized Official - Phone:309-342-8676
Mailing Address - Street 1:430 N HENDERSON ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-3596
Mailing Address - Country:US
Mailing Address - Phone:309-342-8676
Mailing Address - Fax:309-342-8676
Practice Address - Street 1:430 N HENDERSON ST
Practice Address - Street 2:SUITE A
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-3596
Practice Address - Country:US
Practice Address - Phone:309-342-8676
Practice Address - Fax:309-342-8676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL5454400001Medicare NSC