Provider Demographics
NPI:1881947794
Name:INNOVATIVE EYE CARE OPTOMETRIC CORPORATION
Entity type:Organization
Organization Name:INNOVATIVE EYE CARE OPTOMETRIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHEREE
Authorized Official - Middle Name:A
Authorized Official - Last Name:WILHELMSEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:661-213-3310
Mailing Address - Street 1:4903 CALLOWAY DR STE 101
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-9711
Mailing Address - Country:US
Mailing Address - Phone:661-213-3310
Mailing Address - Fax:661-213-3315
Practice Address - Street 1:4903 CALLOWAY DR STE 101
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-9711
Practice Address - Country:US
Practice Address - Phone:661-213-3310
Practice Address - Fax:661-213-3315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-17
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10443T261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center