Provider Demographics
NPI:1114266681
Name:PREMIER OPTICAL INCORPORATED
Entity Type:Organization
Organization Name:PREMIER OPTICAL INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEONEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NUNEZ
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:915-633-9763
Mailing Address - Street 1:2921 GEORGE DIETER DR STE D
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-2945
Mailing Address - Country:US
Mailing Address - Phone:915-633-9763
Mailing Address - Fax:
Practice Address - Street 1:2921 GEORGE DIETER DR STE D
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-2945
Practice Address - Country:US
Practice Address - Phone:915-633-9763
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-04
Last Update Date:2013-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier