Provider Demographics
NPI:1568216570
Name:PREMIER FAMILY EYECARE LLC
Entity Type:Organization
Organization Name:PREMIER FAMILY EYECARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TINCY
Authorized Official - Middle Name:E
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:813-298-7475
Mailing Address - Street 1:2199 BLUE HIGHLANDS DR
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33811-1017
Mailing Address - Country:US
Mailing Address - Phone:813-298-7475
Mailing Address - Fax:
Practice Address - Street 1:3635 US HIGHWAY 98 N
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33809-3808
Practice Address - Country:US
Practice Address - Phone:863-937-9045
Practice Address - Fax:863-940-9944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty