Provider Demographics
NPI:1467074989
Name:IKONIC VISION CARE, INC.
Entity Type:Organization
Organization Name:IKONIC VISION CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:YANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:YU
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:714-989-5019
Mailing Address - Street 1:855 E BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-5769
Mailing Address - Country:US
Mailing Address - Phone:714-989-5019
Mailing Address - Fax:714-255-2010
Practice Address - Street 1:855 E BIRCH ST
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-5769
Practice Address - Country:US
Practice Address - Phone:714-989-5019
Practice Address - Fax:714-255-2010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-07
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty