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General NPI Number Information
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NPI Number | 1003168253
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Entity Type | Organization
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Legal Business Name | PREMIER VISION CENTER INC
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Dates
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Enumeration Date | 10/12/2012
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Last Update Date | 10/12/2012
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Provider Practice Location Address
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Address Line | 131 SW 117TH AVE 203
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City | PEMBROKE PINES
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State | FL
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Zip | 33025-4915
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Country | US
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Telephone | 305-785-7165
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Fax |
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Provider Business Mailing Address
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Address Line | 131 SW 117TH AVE 203
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City | PEMBROKE PINES
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State | FL
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Zip | 33025-4915
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Country | US
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Telephone | 305-785-7165
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. JOSE CUEVAS
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Credential | OD
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Telephone | 305-785-7165
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC4553
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License Number State | IL
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