Provider Demographics
NPI:1003464249
Name:ICARE ASSOCIATES VISION CENTER LLC.
Entity Type:Organization
Organization Name:ICARE ASSOCIATES VISION CENTER LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OLANREWAJU
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:301-735-1393
Mailing Address - Street 1:1811 G ST STE C00007
Mailing Address - Street 2:
Mailing Address - City:JB ANDREWS
Mailing Address - State:MD
Mailing Address - Zip Code:20762-5677
Mailing Address - Country:US
Mailing Address - Phone:301-735-1393
Mailing Address - Fax:410-874-8599
Practice Address - Street 1:BLDG. 1811 G STREET SUITE C00007
Practice Address - Street 2:
Practice Address - City:JOINT BASE ANDREWS
Practice Address - State:MD
Practice Address - Zip Code:20762-6302
Practice Address - Country:US
Practice Address - Phone:301-735-1393
Practice Address - Fax:240-788-6365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-30
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty