Healthcare Provider Details

I. General information

NPI: 1184692188
Provider Name (Legal Business Name): I CARE OF MUSCATINE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 01/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 N 2ND ST
WAPELLO IA
52653-1203
US

IV. Provider business mailing address

317 N 2ND ST
WAPELLO IA
52653-1203
US

V. Phone/Fax

Practice location:
  • Phone: 319-523-2020
  • Fax: 319-523-5230
Mailing address:
  • Phone: 319-523-2020
  • Fax: 319-523-5230

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number StateIA

VIII. Authorized Official

Name: DR. BRIAN J DAVIS
Title or Position: VICE PRESIDENT
Credential: OD
Phone: 563-263-2020