Provider Demographics
NPI:1417715350
Name:ICARE ASSOCIATES VISION CENTER TX PLLC
Entity Type:Organization
Organization Name:ICARE ASSOCIATES VISION CENTER TX PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DNIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OLANREWAJU
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:254-532-1544
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 1:4250 S CLEAR CREEK ROAD
Practice Address - Street 2:
Practice Address - City:FORT HOOD
Practice Address - State:TX
Practice Address - Zip Code:76544-5082
Practice Address - Country:US
Practice Address - Phone:254-532-1544
Practice Address - Fax:410-874-8599
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-06
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty