Provider Demographics
NPI:1982898219
Name:QING GE
Entity Type:Organization
Organization Name:QING GE
Other - Org Name:PREMIER EYE CLINIC, P. A.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:QING
Authorized Official - Middle Name:
Authorized Official - Last Name:GE
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:386-788-6198
Mailing Address - Street 1:1515 HERBERT ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-6104
Mailing Address - Country:US
Mailing Address - Phone:386-788-6198
Mailing Address - Fax:386-788-4616
Practice Address - Street 1:1515 HERBERT ST
Practice Address - Street 2:SUITE 208
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129-6104
Practice Address - Country:US
Practice Address - Phone:386-788-6198
Practice Address - Fax:386-788-4616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2007-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 96155261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI71676Medicare UPIN