Provider Demographics
NPI:1588073050
Name:ENFOCUS EYECARE LLC
Entity type:Organization
Organization Name:ENFOCUS EYECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AARON
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:RAHN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:404-421-3957
Mailing Address - Street 1:6520 ERNEST W BARRETT PKWY SW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-4571
Mailing Address - Country:US
Mailing Address - Phone:770-222-6603
Mailing Address - Fax:
Practice Address - Street 1:6520 ERNEST W BARRETT PKWY SW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-4571
Practice Address - Country:US
Practice Address - Phone:770-222-6603
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-08
Last Update Date:2014-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002835302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization