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General NPI Number Information
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NPI Number | 1881947794
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Entity Type | Organization
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Legal Business Name | INNOVATIVE EYE CARE OPTOMETRIC CORPORATION
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Dates
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Enumeration Date | 10/17/2012
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Last Update Date | 08/03/2022
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Provider Practice Location Address
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Address Line | 4903 CALLOWAY DR STE 101
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City | BAKERSFIELD
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State | CA
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Zip | 93312-9711
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Country | US
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Telephone | 661-213-3310
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Fax | 661-213-3315
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Provider Business Mailing Address
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Address Line | 4903 CALLOWAY DR STE 101
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City | BAKERSFIELD
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State | CA
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Zip | 93312-9711
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Country | US
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Telephone | 661-213-3310
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Fax | 661-213-3315
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHEREE A WILHELMSEN
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Credential | O.D.
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Telephone | 661-213-3310
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 10443T
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License Number State | CA
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