MEDICARE: I CARE EYE WARE, 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	156FX1800X	Optician	ABOC146965	CA

General Provider Information

NPI Number	:	1497857916
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	I CARE EYE WARE, INC.

Provider Business Mailing Address
First Line	:	322 LAKEWOOD CENTER MALL
Second Line	:
City	:	LAKEWOOD
State	:	CA
Zip	:	90712-2409
Country	:	US
Telephone Number	:	562-633-7434
Fax Number	:	562-633-7435

Provider Business Practice Location Address
First Line	:	322 LAKEWOOD CENTER MALL
Second Line	:
City	:	LAKEWOOD
State	:	CA
Zip	:	90712-2409
Country	:	US
Telephone Number	:	562-633-7434
Fax Number	:	562-633-7435

Authorized Official
Title or Position	:	OWNER
Name	:	MR. STEPHAN GEORGE NICHOLSON
Credential	:	ABOC, DL, DO
Telephone Number	:	562-633-7434

Provider Enumeration Date	:	09/04/2006
Last Update Date	:	08/22/2020

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