Provider Demographics
NPI:1295063402
Name:I CARE SAN ANTONIO INC.
Entity type:Organization
Organization Name:I CARE SAN ANTONIO INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LIBBY
Authorized Official - Middle Name:
Authorized Official - Last Name:BENTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-220-2361
Mailing Address - Street 1:1 HAVEN FOR HOPE WAY
Mailing Address - Street 2:BLDG. ONE, SUITE 200
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-1108
Mailing Address - Country:US
Mailing Address - Phone:210-220-2361
Mailing Address - Fax:210-220-2364
Practice Address - Street 1:1 HAVEN FOR HOPE WAY
Practice Address - Street 2:BLDG. ONE, SUITE 200
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-1108
Practice Address - Country:US
Practice Address - Phone:210-220-2361
Practice Address - Fax:210-220-2364
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-28
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty