Provider Demographics
NPI:1710919360
Name:INFOCUS EYECARE, INC.
Entity Type:Organization
Organization Name:INFOCUS EYECARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIZEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DERBY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:801-599-8720
Mailing Address - Street 1:977 ADDINGTON CIR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84094-1615
Mailing Address - Country:US
Mailing Address - Phone:801-599-8720
Mailing Address - Fax:
Practice Address - Street 1:7250 UNION PARK AVE
Practice Address - Street 2:
Practice Address - City:MIDVALE
Practice Address - State:UT
Practice Address - Zip Code:84047-1840
Practice Address - Country:US
Practice Address - Phone:801-599-8720
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT372443-9934152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU76410Medicare UPIN