Provider Demographics
NPI:1285850354
Name:REFOCUS EYECARE CENTER, LLC
Entity type:Organization
Organization Name:REFOCUS EYECARE CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JO
Authorized Official - Last Name:BYERS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:715-445-3553
Mailing Address - Street 1:135 N MAIN ST
Mailing Address - Street 2:P.O. BOX 302
Mailing Address - City:IOLA
Mailing Address - State:WI
Mailing Address - Zip Code:54945-9120
Mailing Address - Country:US
Mailing Address - Phone:715-445-3553
Mailing Address - Fax:715-445-4970
Practice Address - Street 1:135 N MAIN ST
Practice Address - Street 2:
Practice Address - City:IOLA
Practice Address - State:WI
Practice Address - Zip Code:54945-9120
Practice Address - Country:US
Practice Address - Phone:715-445-3553
Practice Address - Fax:715-445-4970
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2023-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2491152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIU37087Medicare UPIN