Provider Demographics
NPI:1417407982
Name:PREMIUM EYECARE & ASSOCIATES PLLC
Entity Type:Organization
Organization Name:PREMIUM EYECARE & ASSOCIATES PLLC
Other - Org Name:TODAY'S VISION FAIRFIELD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CANDACE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:832-729-9375
Mailing Address - Street 1:28404 HIGHWAY 290
Mailing Address - Street 2:SUITE G13
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-5426
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:28404 HIGHWAY 290
Practice Address - Street 2:SUITE G13
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-4288
Practice Address - Country:US
Practice Address - Phone:281-817-4141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-09
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7426152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty