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General NPI Number Information
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NPI Number | 1164156600
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Entity Type | Organization
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Legal Business Name | PREMIUM VISION GROUP
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Dates
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Enumeration Date | 07/11/2022
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Last Update Date | 07/11/2022
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Provider Practice Location Address
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Address Line | 9840 W SAMPLE RD
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City | CORAL SPRINGS
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State | FL
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Zip | 33065-4006
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Country | US
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Telephone | 954-755-3750
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Fax | 954-755-3799
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Provider Business Mailing Address
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Address Line | 9840 W SAMPLE RD
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City | CORAL SPRINGS
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State | FL
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Zip | 33065-4006
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Country | US
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Telephone | 954-755-3750
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Fax | 954-755-3799
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Authorized Official
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Title or Position | PRESIDENT/OPTOMETRIST
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Name | DR. JERIN K JOSEPH
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Credential | OD
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Telephone | 954-309-8647
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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 |
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License Number State |
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