Provider Demographics
NPI:1689909996
Name:ICARE EYECARE, LLC
Entity Type:Organization
Organization Name:ICARE EYECARE, LLC
Other - Org Name:MORRIS AVENUE EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VALENCIA
Authorized Official - Middle Name:ROBERTSON
Authorized Official - Last Name:WELLS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:205-328-1744
Mailing Address - Street 1:2014 MORRIS AVE
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35203-4108
Mailing Address - Country:US
Mailing Address - Phone:205-328-1744
Mailing Address - Fax:205-328-4270
Practice Address - Street 1:2014 MORRIS AVE
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35203-4108
Practice Address - Country:US
Practice Address - Phone:205-328-1744
Practice Address - Fax:205-328-4270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-05
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-C08-TA-828152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL102G700056OtherPTAN
ALDU6174OtherRAILROAD MEDICARE PTAN
AL151212Medicaid
AL102G700056OtherPTAN
AL102G700056Medicare PIN