Provider Demographics
NPI:1760558555
Name:PREMIER EYE CARE, PA
Entity Type:Organization
Organization Name:PREMIER EYE CARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BRENT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-338-5222
Mailing Address - Street 1:11111 RESEARCH BLVD
Mailing Address - Street 2:SUITE 170
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-5264
Mailing Address - Country:US
Mailing Address - Phone:512-338-5222
Mailing Address - Fax:512-338-5229
Practice Address - Street 1:11111 RESEARCH BLVD
Practice Address - Street 2:SUITE 170
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-5264
Practice Address - Country:US
Practice Address - Phone:512-338-5222
Practice Address - Fax:512-338-5229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-26
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXZ000T76K6Medicaid
TXZ000T76K6Medicaid