Provider Demographics
NPI:1932363934
Name:PREMIER EYE CARE OF FLORIDA LLC
Entity Type:Organization
Organization Name:PREMIER EYE CARE OF FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:PANOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-455-9002
Mailing Address - Street 1:6501 PARK OF COMMERCE BLVD
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-8279
Mailing Address - Country:US
Mailing Address - Phone:561-455-9002
Mailing Address - Fax:800-523-3788
Practice Address - Street 1:6501 PARK OF COMMERCE BLVD
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-8279
Practice Address - Country:US
Practice Address - Phone:561-455-9002
Practice Address - Fax:800-523-3788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-18
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010177700Medicaid