Provider Demographics
NPI:1841212651
Name:PREMIER EYE CARE, P.A.
Entity Type:Organization
Organization Name:PREMIER EYE CARE, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP/TREASURER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:CRISWELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:843-849-2717
Mailing Address - Street 1:652 COLEMAN BLVD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464
Mailing Address - Country:US
Mailing Address - Phone:843-849-2717
Mailing Address - Fax:843-849-2718
Practice Address - Street 1:652 COLEMAN BLVD
Practice Address - Street 2:SUITE 104
Practice Address - City:MOUNT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464
Practice Address - Country:US
Practice Address - Phone:843-849-2717
Practice Address - Fax:843-849-2718
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
8531Medicare PIN