Provider Demographics
NPI:1124219324
Name:I.C.U. INC.
Entity Type:Organization
Organization Name:I.C.U. INC.
Other - Org Name:PARRELLI OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER OF STORE
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:JAFFE
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:617-327-0141
Mailing Address - Street 1:2034 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:W ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02132
Mailing Address - Country:US
Mailing Address - Phone:617-327-0141
Mailing Address - Fax:617-327-0177
Practice Address - Street 1:2034 CENTRE ST
Practice Address - Street 2:
Practice Address - City:W ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02132
Practice Address - Country:US
Practice Address - Phone:617-327-0141
Practice Address - Fax:617-327-0177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty