Provider Demographics
NPI:1154089332
Name:PREMIERMED OPHTHALMOLOGY, LLC
Entity Type:Organization
Organization Name:PREMIERMED OPHTHALMOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:VISSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-581-9065
Mailing Address - Street 1:1291 WINTER GARDEN VINELAND RD STE 130
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-6705
Mailing Address - Country:US
Mailing Address - Phone:407-501-7100
Mailing Address - Fax:407-501-7200
Practice Address - Street 1:1291 WINTER GARDEN VINELAND RD STE 130
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-6705
Practice Address - Country:US
Practice Address - Phone:407-501-7100
Practice Address - Fax:407-501-7200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-03
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty