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General NPI Number Information
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NPI Number | 1033376330
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Entity Type | Organization
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Legal Business Name | PREMIER EYECARE
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Dates
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Enumeration Date | 05/22/2008
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Last Update Date | 05/22/2008
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Provider Practice Location Address
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Address Line | 35 PLEASANT STREET 2C
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City | MERIDEN
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State | CT
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Zip | 06450
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Country | US
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Telephone | 203-235-4462
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Fax | 203-238-4436
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Provider Business Mailing Address
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Address Line | 35 PLEASANT ST STE 2C
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City | MERIDEN
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State | CT
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Zip | 06450-7596
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Country | US
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Telephone | 203-235-4462
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Fax | 203-238-4436
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN BIESTEK
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Credential |
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Telephone | 203-235-4462
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 000994
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License Number State | CT
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