1831234053 NPI number — ICARE SPECIALISTS OF WARRIOR, INC.

Table of content: (NPI 1831234053)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831234053 NPI number — ICARE SPECIALISTS OF WARRIOR, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ICARE SPECIALISTS OF WARRIOR, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831234053
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2026
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3245 LAWRENCEVILLE SUWANEE RD STE 108
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUWANEE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
30024-6541
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
678-926-3074
Provider Business Mailing Address Fax Number:
678-606-1911

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3245 LAWRENCEVILLE SUWANEE RD STE 108
Provider Second Line Business Practice Location Address:
VISION CENTER
Provider Business Practice Location Address City Name:
SUWANEE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30024-6541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
678-926-3074
Provider Business Practice Location Address Fax Number:
678-606-1911
Provider Enumeration Date:
02/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KIM
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
678-926-3074

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OPT002317 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 009996865 , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1528178928 . This is a "SUPERIOR VISION SERVICES" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 310922 . This is a "FIRST LOOK VISION" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 87726 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 9041 . This is a "PALMETTO GBA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 1528178928 . This is a "VERSANTHEALTH" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: ICAR20634 . This is a "SPECTERA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 38381 . This is a "VISION SERVICE PLAN" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 117430 . This is a "DAVIS AND OSCAR VISION" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 1528178928 . This is a "AMBETTER" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: A03992 . This is a "EYEMED" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 003299925C . This is a "PEACHCARE FOR KIDS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: 200000019438 . This is a "AETNA VISION" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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