Provider Demographics
NPI:1003395310
Name:PREMIER EYE CARE GROUP, INC
Entity Type:Organization
Organization Name:PREMIER EYE CARE GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:BRENT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-232-2245
Mailing Address - Street 1:92 TUSCARORA ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1667
Mailing Address - Country:US
Mailing Address - Phone:717-232-0843
Mailing Address - Fax:717-232-3294
Practice Address - Street 1:3903 HARTZDALE DR
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-7836
Practice Address - Country:US
Practice Address - Phone:717-761-3077
Practice Address - Fax:717-761-1186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-08
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty