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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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