Provider Demographics
NPI:1164509675
Name:PREMIER EYE CLINIC , PLLC
Entity Type:Organization
Organization Name:PREMIER EYE CLINIC , PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:SPENCER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:228-762-1525
Mailing Address - Street 1:4505 HOSPITAL ST STE A
Mailing Address - Street 2:
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39581-5302
Mailing Address - Country:US
Mailing Address - Phone:228-762-1525
Mailing Address - Fax:228-769-2635
Practice Address - Street 1:4505 HOSPITAL ST STE A
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39581-5302
Practice Address - Country:US
Practice Address - Phone:228-762-1525
Practice Address - Fax:228-769-2635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS526 AND 653152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0087006Medicaid
MS00880168Medicaid
MSU81104Medicare UPIN
MS0087006Medicaid