Provider Demographics
NPI:1912639451
Name:2020 ICARE LONGVIEW PLLC
Entity type:Organization
Organization Name:2020 ICARE LONGVIEW PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LONG
Authorized Official - Middle Name:
Authorized Official - Last Name:DO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:903-663-4047
Mailing Address - Street 1:307 W LOOP 281 STE 2B
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-4442
Mailing Address - Country:US
Mailing Address - Phone:903-663-4047
Mailing Address - Fax:
Practice Address - Street 1:307 W LOOP 281 STE 2B
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-4442
Practice Address - Country:US
Practice Address - Phone:903-663-4047
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-24
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8382TGOtherTEXAS OPTOMETRY BOARD