Icare Optical, LLC

Primary specialty

Customized Equipment (DME)Taxonomy code 332BC3200X

Legal business name

ICARE OPTICAL, LLC

Practice address

1001 Johnson Pkwy
Ste 271
Saint Paul, MN 55106-3474

Phone

(651) 315-1766

Fax

(651) 318-3651

NPI assigned

Nov 13, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Chonburi Lee

Title

Owner

Phone

(651) 373-0914

Specialties & licenses 1

Addresses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1384300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384300800000",
    "number": "1770913626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1815 ROSS AVE E",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551193431",
            "telephone_number": "651-315-1766",
            "fax_number": "651-318-3651"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 JOHNSON PKWY",
            "address_2": "STE 271",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551063474",
            "telephone_number": "651-315-1766",
            "fax_number": "651-318-3651"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICARE OPTICAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-13",
        "last_updated": "2013-11-13",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "CHONBURI",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "651-373-0914",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Suha Emadeldin Ibrahim
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• Idil Said Nur
• Yasmin Idow, PA-S

• Customized Equipment (DME) in Saint Paul, MN
• Providers in Saint Paul, MN by specialty
• Customized Equipment (DME) in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.