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:
03/15/2024
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 AND OPTOMETRIST
Authorized Official Telephone Number:
205-243-6755

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: 423253477 . This is a "TRICARE DR. WILLIAM KIM" identifier , issued by the state of ( AL ) . 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: A03992 . This is a "EYEMED" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: IC27409 . This is a "SPECTERA" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".
  • Identifier: U97383 . This is a "HEALTH SPRING" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 5459930001 . This is a "PALMETTO GBA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 529923760 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".




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