Basic Information
| Provider Information | |||||||||
| NPI: | 1407024003 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | I CARE VISION CENTERS, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5560 W 44TH AVE | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802127338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034212424 | ||||||||
| FaxNumber: | 3034212155 | ||||||||
| Practice Location | |||||||||
| Address1: | 5560 W 44TH AVE | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802127338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3034212424 | ||||||||
| FaxNumber: | 3034212155 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2008 | ||||||||
| LastUpdateDate: | 10/08/2019 | ||||||||
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| AuthorizedOfficialLastName: | ORLEANS | ||||||||
| AuthorizedOfficialFirstName: | ELIZABETH | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OPTOMETRIST | ||||||||
| AuthorizedOfficialTelephone: | 3034212424 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | OD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332H00000X | Y | Suppliers | Eyewear Supplier (Equipment, not the service) |
ID Information
| ID | Type | State | Issuer | Description | 04015244 | 05 | CO | MEDICAID |