Healthcare Provider Details
I. General information
NPI: 1750833919
Provider Name (Legal Business Name): ICARE HEALTH SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 11/03/2016
Last Update Date: 11/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
7352 NW 34 ST
MIAMI FL
33122-1266
US
IV. Provider business mailing address
7352 NW 34TH ST
MIAMI FL
33122-1266
US
V. Phone/Fax
- Phone: 786-441-8471
- Fax:
- Phone: 786-441-8471
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 152W00000X |
| Taxonomy | Optometrist |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 302F00000X |
| Taxonomy | Exclusive Provider Organization |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: MR.
LARRY
CLARIK
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 786-441-8471