Provider Demographics
NPI:1831234053
Name:ICARE SPECIALISTS OF WARRIOR, INC.
Entity type:Organization
Organization Name:ICARE SPECIALISTS OF WARRIOR, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:205-243-6755
Mailing Address - Street 1:3245 LAWRENCEVILLE SUWANEE RD STE 108
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6541
Mailing Address - Country:US
Mailing Address - Phone:678-926-3074
Mailing Address - Fax:678-606-1911
Practice Address - Street 1:3245 LAWRENCEVILLE SUWANEE RD STE 108
Practice Address - Street 2:VISION CENTER
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6541
Practice Address - Country:US
Practice Address - Phone:678-926-3074
Practice Address - Fax:678-606-1911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002317152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL423253477OtherTRICARE DR. WILLIAM KIM
GA310922OtherFIRST LOOK VISION
GAA03992OtherEYEMED
GAIC27409OtherSPECTERA
ALU97383OtherHEALTH SPRING
AL5459930001OtherPALMETTO GBA
AL529923760Medicaid
AL=========OtherSPECTERA
AL=========OtherSUPERIOR VISION SERVICES.
AL051526667OtherBCBS
AL=========OtherVISION SERVICE PLAN
AL=========OtherUNITED HEALTH CARE
ALU97383OtherHEALTH SPRING
AL529923760Medicaid
AL=========OtherTRICARE GROUP NUMBER