Provider Demographics
NPI:1477825511
Name:EYECARE FOCUS PC
Entity Type:Organization
Organization Name:EYECARE FOCUS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:J
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:309-698-2020
Mailing Address - Street 1:93 EASTGATE DR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61571-9271
Mailing Address - Country:US
Mailing Address - Phone:309-698-2020
Mailing Address - Fax:309-698-0368
Practice Address - Street 1:93 EASTGATE DR
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IL
Practice Address - Zip Code:61571-9271
Practice Address - Country:US
Practice Address - Phone:309-698-2020
Practice Address - Fax:309-698-0368
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-06
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL04600642152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty