Provider Demographics
NPI:1093198483
Name:I CARE OPTICS LLC
Entity Type:Organization
Organization Name:I CARE OPTICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANDA
Authorized Official - Middle Name:LAINE
Authorized Official - Last Name:STOLK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-406-8585
Mailing Address - Street 1:2425 LAKE MICHIGAN DR NW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49504-4652
Mailing Address - Country:US
Mailing Address - Phone:616-406-8585
Mailing Address - Fax:616-735-4868
Practice Address - Street 1:2425 LAKE MICHIGAN DR NW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49504-4652
Practice Address - Country:US
Practice Address - Phone:616-406-8585
Practice Address - Fax:616-735-4868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-02
Last Update Date:2015-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty