Provider Demographics
NPI:1649752072
Name:PRINCIPLE OPTOMETRY GROUP,PC
Entity Type:Organization
Organization Name:PRINCIPLE OPTOMETRY GROUP,PC
Other - Org Name:MODERN ICARE OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAHRIARI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:281-414-4685
Mailing Address - Street 1:480 E AVENIDA PALMERA
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92264
Mailing Address - Country:US
Mailing Address - Phone:281-414-4685
Mailing Address - Fax:
Practice Address - Street 1:44435 TOWN CENTER WAY
Practice Address - Street 2:SUITE B
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92260
Practice Address - Country:US
Practice Address - Phone:281-414-4685
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-01
Last Update Date:2018-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty