Provider Demographics
NPI:1164156600
Name:PREMIUM VISION GROUP
Entity Type:Organization
Organization Name:PREMIUM VISION GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JERIN
Authorized Official - Middle Name:K
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:954-309-8647
Mailing Address - Street 1:9840 W SAMPLE RD
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-4006
Mailing Address - Country:US
Mailing Address - Phone:954-755-3750
Mailing Address - Fax:954-755-3799
Practice Address - Street 1:9840 W SAMPLE RD
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4006
Practice Address - Country:US
Practice Address - Phone:954-755-3750
Practice Address - Fax:954-755-3799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty