Provider Demographics
NPI:1265770663
Name:PREMIUM EYE DIAGNOSTIC CENTER LLC
Entity type:Organization
Organization Name:PREMIUM EYE DIAGNOSTIC CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:F
Authorized Official - Last Name:MILKIE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:310-638-9391
Mailing Address - Street 1:7957 PAINTER AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90602-2434
Mailing Address - Country:US
Mailing Address - Phone:310-638-9391
Mailing Address - Fax:310-603-8749
Practice Address - Street 1:7957 PAINTER AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-2434
Practice Address - Country:US
Practice Address - Phone:310-638-9391
Practice Address - Fax:310-603-8749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-21
Last Update Date:2013-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty