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General NPI Number Information
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NPI Number | 1831234053
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Entity Type | Organization
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Legal Business Name | ICARE SPECIALISTS OF WARRIOR, INC.
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 03/15/2024
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Provider Practice Location Address
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Address Line | 3245 LAWRENCEVILLE SUWANEE RD STE 108 VISION CENTER
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City | SUWANEE
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State | GA
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Zip | 30024-6541
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Country | US
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Telephone | 678-926-3074
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Fax | 678-606-1911
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Provider Business Mailing Address
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Address Line | 3245 LAWRENCEVILLE SUWANEE RD STE 108
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City | SUWANEE
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State | GA
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Zip | 30024-6541
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Country | US
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Telephone | 678-926-3074
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Fax | 678-606-1911
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Authorized Official
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Title or Position | PRESIDENT AND OPTOMETRIST
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Name | DR. WILLIAM KIM
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Credential | O.D.
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Telephone | 205-243-6755
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT002317
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License Number State | GA
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