Provider Demographics
NPI:1548718786
Name:I-CARE FAMILY VISION CENTER, LLC
Entity type:Organization
Organization Name:I-CARE FAMILY VISION CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:QIQI
Authorized Official - Middle Name:
Authorized Official - Last Name:CUI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-780-2871
Mailing Address - Street 1:6 PARTRIDGE HL
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-1531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:550 PROVIDENCE HWY
Practice Address - Street 2:
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081-4231
Practice Address - Country:US
Practice Address - Phone:508-668-9090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-16
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA4834152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110088945AMedicaid
S300202884OtherMEDICARE PTAN