Provider Demographics
NPI:1447562186
Name:FOCUS VISION CLINIC OPTOMETRY INC
Entity Type:Organization
Organization Name:FOCUS VISION CLINIC OPTOMETRY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:951-845-4749
Mailing Address - Street 1:851 E 6TH ST
Mailing Address - Street 2:STE A1
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-2340
Mailing Address - Country:US
Mailing Address - Phone:951-845-4749
Mailing Address - Fax:951-845-3833
Practice Address - Street 1:34488 YUCAIPA BLVD
Practice Address - Street 2:STE A
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-2482
Practice Address - Country:US
Practice Address - Phone:909-797-2227
Practice Address - Fax:951-845-3833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-10
Last Update Date:2010-07-10
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
1275619116Medicare PIN
SD0123350Medicare PIN