Provider Demographics
NPI:1346378304
Name:I CARE OPTICAL LLC
Entity type:Organization
Organization Name:I CARE OPTICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:HADZIC
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-466-5600
Mailing Address - Street 1:1017 12TH AVE S
Mailing Address - Street 2:
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651-4660
Mailing Address - Country:US
Mailing Address - Phone:208-466-5600
Mailing Address - Fax:208-461-0420
Practice Address - Street 1:1017 12TH AVE S
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651-4660
Practice Address - Country:US
Practice Address - Phone:208-466-5600
Practice Address - Fax:208-461-0420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2019-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID003024994332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807429000Medicaid