Provider Demographics
NPI:1750534087
Name:ENVISION ICARE, INC
Entity type:Organization
Organization Name:ENVISION ICARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:JENNETH
Authorized Official - Middle Name:M
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:419-484-8181
Mailing Address - Street 1:111 PROGRESS DR
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:OH
Mailing Address - Zip Code:44811-9094
Mailing Address - Country:US
Mailing Address - Phone:419-484-8181
Mailing Address - Fax:419-484-1033
Practice Address - Street 1:111 PROGRESS DR
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:OH
Practice Address - Zip Code:44811-9094
Practice Address - Country:US
Practice Address - Phone:419-484-8181
Practice Address - Fax:419-484-1033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-30
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5239/T2143152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty