Provider Demographics
NPI:1205230588
Name:PREMIER EYE INSTITUTE, OD, PLLC
Entity Type:Organization
Organization Name:PREMIER EYE INSTITUTE, OD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:NISHA
Authorized Official - Middle Name:P
Authorized Official - Last Name:MEHTA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:215-880-3817
Mailing Address - Street 1:2531 E LYON STATION RD
Mailing Address - Street 2:STE F
Mailing Address - City:CREEDMOOR
Mailing Address - State:NC
Mailing Address - Zip Code:27522-9401
Mailing Address - Country:US
Mailing Address - Phone:215-880-3817
Mailing Address - Fax:
Practice Address - Street 1:2531 E LYON STATION RD
Practice Address - Street 2:SUITE F
Practice Address - City:CREEDMOOR
Practice Address - State:NC
Practice Address - Zip Code:27522-9401
Practice Address - Country:US
Practice Address - Phone:215-880-3817
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-15
Last Update Date:2015-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNC2051152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty