Healthcare Provider Details

I. General information

NPI: 1437401460
Provider Name (Legal Business Name): INTERNATIONAL EYECARE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/15/2012
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

580 S ROOSEVELT AVE
BURLINGTON IA
52601-1666
US

IV. Provider business mailing address

580 S ROOSEVELT AVE
BURLINGTON IA
52601-1666
US

V. Phone/Fax

Practice location:
  • Phone: 319-753-0437
  • Fax: 319-752-8751
Mailing address:
  • Phone: 319-753-0437
  • Fax: 319-752-8751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: TERESA D CARTER
Title or Position: PRESIDENT
Credential:
Phone: 217-222-9207