Provider Demographics
NPI:1194267062
Name:I-CARE BLOOMINGTON INC
Entity type:Organization
Organization Name:I-CARE BLOOMINGTON INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOUSER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:812-325-3611
Mailing Address - Street 1:3818 W WOODYARD RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47404-1430
Mailing Address - Country:US
Mailing Address - Phone:812-325-3611
Mailing Address - Fax:812-333-8918
Practice Address - Street 1:3205 W STATE ROAD 45
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-5107
Practice Address - Country:US
Practice Address - Phone:812-333-8912
Practice Address - Fax:812-333-8918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-09
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003478152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty