Healthcare Provider Details

I. General information

NPI: 1033376330
Provider Name (Legal Business Name): PREMIER EYECARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35 PLEASANT STREET 2C
MERIDEN CT
06450
US

IV. Provider business mailing address

35 PLEASANT ST STE 2C
MERIDEN CT
06450-7596
US

V. Phone/Fax

Practice location:
  • Phone: 203-235-4462
  • Fax: 203-238-4436
Mailing address:
  • Phone: 203-235-4462
  • Fax: 203-238-4436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number000994
License Number StateCT

VIII. Authorized Official

Name: DR. JOHN BIESTEK
Title or Position: OWNER
Credential:
Phone: 203-235-4462