Provider Demographics
NPI:1376213165
Name:PREMIER VISION PARTNERS
Entity Type:Organization
Organization Name:PREMIER VISION PARTNERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:
Authorized Official - Last Name:SORAH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:706-658-0270
Mailing Address - Street 1:279 N BROAD ST STE C
Mailing Address - Street 2:
Mailing Address - City:WINDER
Mailing Address - State:GA
Mailing Address - Zip Code:30680-2589
Mailing Address - Country:US
Mailing Address - Phone:770-867-2505
Mailing Address - Fax:
Practice Address - Street 1:5391 HIGHWAY 53 STE 102
Practice Address - Street 2:
Practice Address - City:BRASELTON
Practice Address - State:GA
Practice Address - Zip Code:30517-3136
Practice Address - Country:US
Practice Address - Phone:706-658-0270
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty