Provider Demographics
NPI:1891763884
Name:I CARE OF MUSCATINE, INC
Entity Type:Organization
Organization Name:I CARE OF MUSCATINE, INC
Other - Org Name:VISION CENTER PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:563-263-2020
Mailing Address - Street 1:PO BOX 901
Mailing Address - Street 2:
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-0078
Mailing Address - Country:US
Mailing Address - Phone:563-263-2020
Mailing Address - Fax:563-263-7435
Practice Address - Street 1:1700 PARK AVE
Practice Address - Street 2:
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-5434
Practice Address - Country:US
Practice Address - Phone:563-263-2020
Practice Address - Fax:563-263-7435
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-08
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0223511Medicaid
IACN2667Medicare PIN
IL0230170001Medicare NSC
IA26097Medicare PIN
IA0230170001Medicare NSC