MEDICARE: INTERNATIONAL EYECARE CENTER INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332H00000X	Eyewear Supplier	470486594	NE
2	152W00000X	Optometrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386825610
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERNATIONAL EYECARE CENTER INC

Provider Business Mailing Address
First Line	:	409 N 78TH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68114-3638
Country	:	US
Telephone Number	:	402-393-4500
Fax Number	:	402-393-7457

Provider Business Practice Location Address
First Line	:	2545 S 132ND ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68144-2532
Country	:	US
Telephone Number	:	402-330-1060
Fax Number	:	402-330-6134

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	CATHY LEE SHORT
Credential	:
Telephone Number	:	618-462-9818

Provider Enumeration Date	:	11/15/2007
Last Update Date	:	01/22/2021

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Directions to “INTERNATIONAL EYECARE CENTER INC ” Practice Location

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