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General NPI Number Information
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NPI Number | 1437401460
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Entity Type | Organization
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Legal Business Name | INTERNATIONAL EYECARE CENTER INC
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Dates
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Enumeration Date | 10/15/2012
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Last Update Date | 01/22/2021
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Provider Practice Location Address
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Address Line | 580 S ROOSEVELT AVE
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City | BURLINGTON
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State | IA
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Zip | 52601-1666
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Country | US
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Telephone | 319-753-0437
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Fax | 319-752-8751
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Provider Business Mailing Address
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Address Line | 580 S ROOSEVELT AVE
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City | BURLINGTON
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State | IA
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Zip | 52601-1666
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Country | US
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Telephone | 319-753-0437
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Fax | 319-752-8751
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Authorized Official
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Title or Position | PRESIDENT
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Name | TERESA D CARTER
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Credential |
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Telephone | 217-222-9207
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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