Provider Demographics
NPI:1750519716
Name:OCUFOCUS OF JANESVILLE, L.L.C.
Entity type:Organization
Organization Name:OCUFOCUS OF JANESVILLE, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GOETSCH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:608-239-1218
Mailing Address - Street 1:5501 LAKE MENDOTA DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-1248
Mailing Address - Country:US
Mailing Address - Phone:608-239-1218
Mailing Address - Fax:
Practice Address - Street 1:5501 LAKE MENDOTA DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-1248
Practice Address - Country:US
Practice Address - Phone:608-239-1218
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3146-35152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty