MEDICARE: PREMIER VISION, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	4572TG	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4657270001	OTHER	TX	CIGNA GOVERNMENT SERVICES
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0026FC	OTHER		BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1093721821
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER VISION, P.C.

Provider Business Mailing Address
First Line	:	152 9TH ST
Second Line	:
City	:	TERRELL
State	:	TX
Zip	:	75160-3061
Country	:	US
Telephone Number	:	972-563-5533
Fax Number	:	972-524-8489

Provider Business Practice Location Address
First Line	:	152 9TH ST
Second Line	:
City	:	TERRELL
State	:	TX
Zip	:	75160-3061
Country	:	US
Telephone Number	:	972-563-5533
Fax Number	:	972-524-8489

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KENT A. WILSON
Credential	:	OD
Telephone Number	:	972-563-5533

Provider Enumeration Date	:	08/01/2006
Last Update Date	:	01/15/2026

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