Provider Demographics
NPI:1497902258
Name:PREMIER FAMILY EYECARE PC
Entity Type:Organization
Organization Name:PREMIER FAMILY EYECARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF OPTOMETRY
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:YAMPOLSKY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:1781-828-2212
Mailing Address - Street 1:612 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-3032
Mailing Address - Country:US
Mailing Address - Phone:781-828-2212
Mailing Address - Fax:781-828-1771
Practice Address - Street 1:612 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-3032
Practice Address - Country:US
Practice Address - Phone:781-828-2212
Practice Address - Fax:781-828-1771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-25
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4276152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9941241OtherAETNA
MAW20487OtherBC/BS
MA0009783Medicare PIN
MAW20487OtherBC/BS