Healthcare Provider Details

I. General information

NPI: 1649588013
Provider Name (Legal Business Name): PREMIER VISION OPTOMETRY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2010
Last Update Date: 03/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 W DUARTE RD SUITE B
ARCADIA CA
91007-6930
US

IV. Provider business mailing address

1 W. DUARTE RD. SUITE B
ARCADIA CA
91007
US

V. Phone/Fax

Practice location:
  • Phone: 626-446-6300
  • Fax: 626-446-6301
Mailing address:
  • Phone: 626-446-6300
  • Fax: 626-446-6301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. JULIET TSAI
Title or Position: OWNER
Credential: O.D.
Phone: 626-446-6300