Provider Demographics
NPI:1437401460
Name:INTERNATIONAL EYECARE CENTER INC
Entity Type:Organization
Organization Name:INTERNATIONAL EYECARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:D
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:217-222-9207
Mailing Address - Street 1:580 S ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52601-1666
Mailing Address - Country:US
Mailing Address - Phone:319-753-0437
Mailing Address - Fax:319-752-8751
Practice Address - Street 1:580 S ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52601-1666
Practice Address - Country:US
Practice Address - Phone:319-753-0437
Practice Address - Fax:319-752-8751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-15
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1760405047Medicaid