Healthcare Provider Details

I. General information

NPI: 1710919360
Provider Name (Legal Business Name): INFOCUS EYECARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7250 UNION PARK AVE
MIDVALE UT
84047-1840
US

IV. Provider business mailing address

977 ADDINGTON CIR
SANDY UT
84094-1615
US

V. Phone/Fax

Practice location:
  • Phone: 801-599-8720
  • Fax:
Mailing address:
  • Phone: 801-599-8720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number372443-9934
License Number StateUT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. MARIZEL DERBY
Title or Position: PRESIDENT
Credential: O.D.
Phone: 801-599-8720