Provider Demographics
NPI:1790810422
Name:PREMIER EYE CLINIC,PLLC
Entity Type:Organization
Organization Name:PREMIER EYE CLINIC,PLLC
Other - Org Name:THE EYEGLASS FACTORY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:228-769-9776
Mailing Address - Street 1:4505 HOSPITAL ST
Mailing Address - Street 2:
Mailing Address - City:PASCAGOULA
Mailing Address - State:MS
Mailing Address - Zip Code:39581-3609
Mailing Address - Country:US
Mailing Address - Phone:228-769-9776
Mailing Address - Fax:228-762-4114
Practice Address - Street 1:4505 HOSPITAL ST
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39581-3609
Practice Address - Country:US
Practice Address - Phone:228-769-9776
Practice Address - Fax:228-762-4114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00089082Medicaid
MS5244380001Medicare NSC