Provider Demographics
NPI:1326273970
Name:CYNTHIA J. PREMEAUX, O.D., LLC
Entity Type:Organization
Organization Name:CYNTHIA J. PREMEAUX, O.D., LLC
Other - Org Name:PREMIER VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:JOANNE
Authorized Official - Last Name:PREMEAUX
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:614-759-9420
Mailing Address - Street 1:7942 BRIANNA DR
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-7007
Mailing Address - Country:US
Mailing Address - Phone:614-209-1977
Mailing Address - Fax:
Practice Address - Street 1:6400 E MAIN ST
Practice Address - Street 2:SUITE 101
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-2359
Practice Address - Country:US
Practice Address - Phone:614-759-9420
Practice Address - Fax:614-759-9520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-27
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5816-T2730152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty