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General NPI Number Information
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NPI Number | 1013231943
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Entity Type | Organization
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Legal Business Name | INFOCUS EYEWEAR
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Dates
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Enumeration Date | 03/22/2010
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Last Update Date | 03/25/2010
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Provider Practice Location Address
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Address Line | 719 GREEN VALLEY RD STE 303 B
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City | GREENSBORO
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State | NC
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Zip | 27408-7014
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Country | US
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Telephone | 336-235-2577
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Fax | 336-235-2578
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Provider Business Mailing Address
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Address Line | 719 GREEN VALLEY RD STE 303 B
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City | GREENSBORO
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State | NC
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Zip | 27408-7014
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Country | US
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Telephone | 336-235-2577
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Fax | 336-235-2578
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL ANTONIO SPENCER
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Credential | M.D.
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Telephone | 336-378-2511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 200100470
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License Number State | NC
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