Healthcare Provider Details

I. General information

NPI: 1386768810
Provider Name (Legal Business Name): PREMIER EYE CLINIC, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4551 GAUTIER VANCLEAVE RD
GAUTIER MS
39553-4810
US

IV. Provider business mailing address

4551 GAUTIER VANCLEAVE RD
GAUTIER MS
39553-4810
US

V. Phone/Fax

Practice location:
  • Phone: 228-497-5126
  • Fax: 228-497-5156
Mailing address:
  • Phone: 228-497-5126
  • Fax: 228-497-5156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number526
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number653
License Number StateMS

VIII. Authorized Official

Name: DR. BRIAN L HUNT
Title or Position: CO-OWNER
Credential: O.D.
Phone: 228-762-1525