Provider Demographics
NPI:1902932957
Name:ICU OPTICAL LLC
Entity Type:Organization
Organization Name:ICU OPTICAL LLC
Other - Org Name:PEARLE VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KARA
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:817-572-9991
Mailing Address - Street 1:279 SOUTHWEST PLZ
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76016-4495
Mailing Address - Country:US
Mailing Address - Phone:817-572-9991
Mailing Address - Fax:817-478-7342
Practice Address - Street 1:279 SOUTHWEST PLZ
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76016-4495
Practice Address - Country:US
Practice Address - Phone:817-572-9991
Practice Address - Fax:817-478-7342
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier