Provider Demographics
NPI:1003168253
Name:PREMIER VISION CENTER INC
Entity Type:Organization
Organization Name:PREMIER VISION CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:CUEVAS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:305-785-7165
Mailing Address - Street 1:131 SW 117TH AVE
Mailing Address - Street 2:203
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33025-4915
Mailing Address - Country:US
Mailing Address - Phone:305-785-7165
Mailing Address - Fax:
Practice Address - Street 1:131 SW 117TH AVE
Practice Address - Street 2:203
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33025-4915
Practice Address - Country:US
Practice Address - Phone:305-785-7165
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILOPC4553152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty