Healthcare Provider Details

I. General information

NPI: 1003464249
Provider Name (Legal Business Name): ICARE ASSOCIATES VISION CENTER LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2019
Last Update Date: 06/06/2025
Certification Date: 06/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLDG. 1811 G STREET SUITE C00007
JOINT BASE ANDREWS MD
20762-6302
US

IV. Provider business mailing address

1811 G ST STE C00007
JB ANDREWS MD
20762-5677
US

V. Phone/Fax

Practice location:
  • Phone: 301-735-1393
  • Fax: 240-788-6365
Mailing address:
  • Phone: 301-735-1393
  • Fax: 410-874-8599

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. DANIEL OLANREWAJU
Title or Position: OPTOMETRIST
Credential: OD
Phone: 301-735-1393