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Organization
ICARE OF WEST GEORGIA
Active
Organization
ICARE OF WEST GEORGIA
Active
Other names
PEARLE VISION
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KENNETH ALBERT HOLLAND (VICE PRESIDENT)
(770) 834-1008
Entity
Organization
Contact information
Practice address
1313 S PARK ST, CARROLLTON, GA 30117-4433
(770) 832-1457
(770) 214-9693
Mailing address
1313 S PARK ST, CARROLLTON, GA 30117-4433
(770) 832-1457
(770) 214-9693
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
003633
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
IC-23266
SPECTERA PROVIDER NUMBER
GA
Enumeration date
12/11/2006
Last updated
08/12/2010
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