Healthcare Provider Details

I. General information

NPI: 1730458456
Provider Name (Legal Business Name): PREMIER EYE GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2011
Last Update Date: 04/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13852 SW 88TH ST
MIAMI FL
33186-1304
US

IV. Provider business mailing address

9549 NW 41ST ST
DORAL FL
33178-2371
US

V. Phone/Fax

Practice location:
  • Phone: 305-804-0645
  • Fax: 305-380-7106
Mailing address:
  • Phone: 305-804-0645
  • Fax: 305-380-7106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPC 4122
License Number StateFL

VIII. Authorized Official

Name: DR. JESUS CUEVAS
Title or Position: OWNER/OFFICER
Credential: OD
Phone: 305-385-6885