Provider Demographics
NPI:1841796612
Name:FOCUSED EYE CARE LLC
Entity Type:Organization
Organization Name:FOCUSED EYE CARE LLC
Other - Org Name:FOCUSED EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WHITNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PURTZER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:574-287-3333
Mailing Address - Street 1:810 E COLFAX AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-2804
Mailing Address - Country:US
Mailing Address - Phone:574-287-3333
Mailing Address - Fax:574-287-9999
Practice Address - Street 1:810 E COLFAX AVE
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46617-2804
Practice Address - Country:US
Practice Address - Phone:574-287-3333
Practice Address - Fax:574-287-9999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-02
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003839A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100150490Medicaid
IN10040990Medicaid
IN100279980AMedicaid
IN201242440Medicaid