Provider Demographics
NPI:1356707517
Name:LAKE WORTH PREMIER EYE CARE PLLC
Entity type:Organization
Organization Name:LAKE WORTH PREMIER EYE CARE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:CRABTREE
Authorized Official - Suffix:
Authorized Official - Credentials:OD,
Authorized Official - Phone:817-300-9803
Mailing Address - Street 1:6921 FOSTER DR
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76135-2818
Mailing Address - Country:US
Mailing Address - Phone:817-439-9455
Mailing Address - Fax:
Practice Address - Street 1:6921 FOSTER DR
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:TX
Practice Address - Zip Code:76135-2818
Practice Address - Country:US
Practice Address - Phone:817-439-9455
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-04
Last Update Date:2016-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6990-TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty