Provider Demographics
NPI:1033376330
Name:PREMIER EYECARE
Entity Type:Organization
Organization Name:PREMIER EYECARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BIESTEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-235-4462
Mailing Address - Street 1:35 PLEASANT ST STE 2C
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-7596
Mailing Address - Country:US
Mailing Address - Phone:203-235-4462
Mailing Address - Fax:203-238-4436
Practice Address - Street 1:35 PLEASANT STREET 2C
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450
Practice Address - Country:US
Practice Address - Phone:203-235-4462
Practice Address - Fax:203-238-4436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000994302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT117606OtherEYEMED
CTP3624859OtherOXFORD
CT0V1922OtherHEALTHNET
CT000994OtherTRICARE
CT2204200OtherUNITED HEALTHCARE
CT505654OtherAETNA
CT004053278Medicaid
CT702660OtherCONNECTICARE
CT906424OtherCOMMUNITY HEALTH NETWORK
CT090000994CT01OtherBLUE CROSS AND BLUE SHIELD
CTP3624859OtherOXFORD
CT702660OtherCONNECTICARE
CT004053278Medicaid