Provider Demographics
NPI:1255653614
Name:PREMIER VISION CARE
Entity type:Organization
Organization Name:PREMIER VISION CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:QUACH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:281-436-1757
Mailing Address - Street 1:5866 E SAM HOUSTON PKWY N STE B
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77049-2527
Mailing Address - Country:US
Mailing Address - Phone:281-436-1757
Mailing Address - Fax:281-454-4825
Practice Address - Street 1:5866 E SAM HOUSTON PKWY N STE B
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77049-2527
Practice Address - Country:US
Practice Address - Phone:281-436-1757
Practice Address - Fax:281-454-4825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-25
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6561TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2143232Medicaid
TXTXB104560OtherMEDICARE - GROUP PTAN