Provider Demographics
NPI:1851759716
Name:PREMIER FAMILY EYE CARE PC.
Entity Type:Organization
Organization Name:PREMIER FAMILY EYE CARE PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:CRANK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:616-633-0574
Mailing Address - Street 1:6748 KALAMZOO AVE S.E
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49508-7032
Mailing Address - Country:US
Mailing Address - Phone:616-633-0574
Mailing Address - Fax:
Practice Address - Street 1:6748 KALAMZOO AVE S.E
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49508-7032
Practice Address - Country:US
Practice Address - Phone:616-633-0574
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-08
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3192010Medicaid
MI3192010Medicaid
MIOM94220004Medicare PIN