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General NPI Number Information
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NPI Number | 1215157755
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Entity Type | Organization
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Legal Business Name | INFOCUS OPTICAL
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5924 SHERIDAN ST
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City | HOLLYWOOD
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State | FL
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Zip | 33021-3246
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Country | US
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Telephone | 561-703-3230
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Fax |
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Provider Business Mailing Address
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Address Line | 1919 VAN BUREN ST STE 307
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City | HOLLYWOOD
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State | FL
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Zip | 33020-7810
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Country | US
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Telephone | 954-924-2531
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST SOLE PROVIDER
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Name | JERRY SIEGEL
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Credential | OD
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Telephone | 561-703-3230
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC695
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License Number State | FL
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