Provider Demographics
NPI:1730458456
Name:PREMIER EYE GROUP INC
Entity Type:Organization
Organization Name:PREMIER EYE GROUP INC
Other - Org Name:JADE OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:
Authorized Official - Last Name:CUEVAS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:305-385-6885
Mailing Address - Street 1:9549 NW 41ST ST
Mailing Address - Street 2:
Mailing Address - City:DORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33178-2371
Mailing Address - Country:US
Mailing Address - Phone:305-804-0645
Mailing Address - Fax:305-380-7106
Practice Address - Street 1:13852 SW 88TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-1304
Practice Address - Country:US
Practice Address - Phone:305-804-0645
Practice Address - Fax:305-380-7106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-27
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 4122152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOPC 4122OtherOPTOMETRY LICENSE NUMBER