Provider Demographics
NPI:1891108924
Name:FOCUS VISION OPTOMETRIC CARE, PLLC
Entity Type:Organization
Organization Name:FOCUS VISION OPTOMETRIC CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BUPATHI
Authorized Official - Middle Name:
Authorized Official - Last Name:DISSANAYAKE-MUSALEM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:336-392-4261
Mailing Address - Street 1:144 BANDANA WAY
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:NC
Mailing Address - Zip Code:28326-4040
Mailing Address - Country:US
Mailing Address - Phone:336-392-4261
Mailing Address - Fax:
Practice Address - Street 1:1594 SKIBO RD
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28303-3478
Practice Address - Country:US
Practice Address - Phone:336-392-4261
Practice Address - Fax:910-867-7539
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-06
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2308152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty