Provider Demographics
NPI:1932591682
Name:PREMIER EYES
Entity Type:Organization
Organization Name:PREMIER EYES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:262-505-5440
Mailing Address - Street 1:13965 W BURLEIGH RD STE 108
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-3074
Mailing Address - Country:US
Mailing Address - Phone:262-505-5440
Mailing Address - Fax:262-505-5414
Practice Address - Street 1:13965 W BURLEIGH RD STE 108
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-3074
Practice Address - Country:US
Practice Address - Phone:262-505-5440
Practice Address - Fax:262-505-5414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-03
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3010152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI7435160001Medicare NSC