MEDICARE: ICONIC EYE CARE 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	282N00000X	General Acute Care Hospital	OPC4711	FL

General Provider Information

NPI Number	:	1598191181
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ICONIC EYE CARE INC

Provider Business Mailing Address
First Line	:	1183 OLD DIXIE HWY STE A
Second Line	:
City	:	LAKE PARK
State	:	FL
Zip	:	33403-2343
Country	:	US
Telephone Number	:	954-224-1486
Fax Number	:	561-863-9010

Provider Business Practice Location Address
First Line	:	1183 OLD DIXIE HWY STE A
Second Line	:
City	:	LAKE PARK
State	:	FL
Zip	:	33403-2343
Country	:	US
Telephone Number	:	954-224-1486
Fax Number	:	561-863-9010

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ADAM RAMSEY
Credential	:	O.D.
Telephone Number	:	561-336-0733

Provider Enumeration Date	:	09/16/2013
Last Update Date	:	10/17/2013

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