Provider Demographics
NPI:1184692188
Name:I CARE OF MUSCATINE, INC
Entity type:Organization
Organization Name:I CARE OF MUSCATINE, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:563-263-2020
Mailing Address - Street 1:317 N 2ND ST
Mailing Address - Street 2:
Mailing Address - City:WAPELLO
Mailing Address - State:IA
Mailing Address - Zip Code:52653-1203
Mailing Address - Country:US
Mailing Address - Phone:319-523-2020
Mailing Address - Fax:319-523-5230
Practice Address - Street 1:317 N 2ND ST
Practice Address - Street 2:
Practice Address - City:WAPELLO
Practice Address - State:IA
Practice Address - Zip Code:52653-1203
Practice Address - Country:US
Practice Address - Phone:319-523-2020
Practice Address - Fax:319-523-5230
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:I CARE OF MUSCATINE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-03-08
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0221697Medicaid
IA0230170002Medicare NSC
IAI1156Medicare PIN
IA0221697Medicaid