Provider Demographics
NPI:1063551653
Name:I CARE OPTICAL, INC.
Entity type:Organization
Organization Name:I CARE OPTICAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:W
Authorized Official - Last Name:LEACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-352-3576
Mailing Address - Street 1:PO BOX 22689
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39225-2689
Mailing Address - Country:US
Mailing Address - Phone:601-352-3576
Mailing Address - Fax:601-352-0290
Practice Address - Street 1:2526 16TH AVE
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-3154
Practice Address - Country:US
Practice Address - Phone:228-864-6175
Practice Address - Fax:228-864-6161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier