Provider Demographics
NPI:1538598370
Name:INTEGRATED EYE CARE PROF. LLC
Entity type:Organization
Organization Name:INTEGRATED EYE CARE PROF. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER AGENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCARBOROUGH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:605-545-2020
Mailing Address - Street 1:203 BERRY BLVD
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57702-1809
Mailing Address - Country:US
Mailing Address - Phone:605-545-3030
Mailing Address - Fax:
Practice Address - Street 1:685 MOUNTAIN VIEW RD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57702-2518
Practice Address - Country:US
Practice Address - Phone:605-545-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-02
Last Update Date:2013-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD697261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center