Healthcare Provider Details

I. General information

NPI: 1356386155
Provider Name (Legal Business Name): FAMILY FOCUSED VISION CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W575 CASTLE DR.
SHERWOOD WI
54169
US

IV. Provider business mailing address

957 MELISSA ST
MENASHA WI
54952-2013
US

V. Phone/Fax

Practice location:
  • Phone: 920-989-2012
  • Fax:
Mailing address:
  • Phone: 920-751-8824
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2614
License Number StateWI

VIII. Authorized Official

Name: DR. CARIN MARIE LA COUNT
Title or Position: OWNER
Credential: O.D.
Phone: 920-989-2012