Provider Demographics
NPI:1437692506
Name:ICARE OPTOMETRY, P.A.
Entity Type:Organization
Organization Name:ICARE OPTOMETRY, P.A.
Other - Org Name:ICARE OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:KELLEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:620-331-9090
Mailing Address - Street 1:115 W LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:KS
Mailing Address - Zip Code:67301-3311
Mailing Address - Country:US
Mailing Address - Phone:620-331-9090
Mailing Address - Fax:620-331-0011
Practice Address - Street 1:115 W LAUREL ST
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:KS
Practice Address - Zip Code:67301-3311
Practice Address - Country:US
Practice Address - Phone:620-331-9090
Practice Address - Fax:620-331-0011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-22
Last Update Date:2024-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201100480AMedicaid
KS10042069Medicaid
KS100343690BMedicaid
KS1710391792OtherNPI
KS1710395769OtherNPI
KS650761Medicare PIN