Provider Demographics
NPI:1780136077
Name:INTELLIGENT EYE CARE CORPORATION
Entity type:Organization
Organization Name:INTELLIGENT EYE CARE CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-979-5251
Mailing Address - Street 1:25 N SANTA ANITA AVE
Mailing Address - Street 2:SUITE E
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-3111
Mailing Address - Country:US
Mailing Address - Phone:626-254-9933
Mailing Address - Fax:626-254-9923
Practice Address - Street 1:25 N SANTA ANITA AVE
Practice Address - Street 2:SUITE E
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3111
Practice Address - Country:US
Practice Address - Phone:626-254-9933
Practice Address - Fax:626-254-9923
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-02
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA135726207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty