Icare of West Georgia

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

License

003633 Issued in GA

Legal business name

ICARE OF WEST GEORGIA

Doing business as

Pearle Vision

Practice address

1313 S Park St
Carrollton, GA 30117-4433

Phone

(770) 832-1457

Fax

(770) 214-9693

NPI assigned

Dec 11, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Kenneth Albert Holland

Title

Vice President

Phone

(770) 834-1008

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• PEARLE VISION Doing business as

Locations

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

{
    "created_epoch": "1165795200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1281571200000",
    "number": "1932269107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1313 S PARK ST",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301174433",
            "telephone_number": "770-832-1457",
            "fax_number": "770-214-9693"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1313 S PARK ST",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301174433",
            "telephone_number": "770-832-1457",
            "fax_number": "770-214-9693"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ICARE OF WEST GEORGIA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-11",
        "last_updated": "2010-08-12",
        "status": "A",
        "authorized_official_last_name": "HOLLAND",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "ALBERT",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "770-834-1008",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "GA",
            "license": "003633",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SPECTERA PROVIDER NUMBER",
            "identifier": "IC-23266",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "PEARLE VISION",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Eyewear Supplier in Carrollton, GA
• Providers in Carrollton, GA by specialty
• Eyewear Supplier in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2010; 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.