Provider Demographics
NPI:1578795753
Name:PREMIER EYE CARE GROUP, INC
Entity Type:Organization
Organization Name:PREMIER EYE CARE GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ECONOMICS OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTTS
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:717-232-0797
Mailing Address - Street 1:92 TUSCARORA ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1667
Mailing Address - Country:US
Mailing Address - Phone:717-232-0797
Mailing Address - Fax:717-232-2215
Practice Address - Street 1:1524 CEDAR CLIFF DR
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-7700
Practice Address - Country:US
Practice Address - Phone:717-761-3077
Practice Address - Fax:717-761-1186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA6000005372332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1007738030002Medicaid
PA0664300002Medicare NSC