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General NPI Number Information
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NPI Number | 1164509675
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Entity Type | Organization
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Legal Business Name | PREMIER EYE CLINIC , PLLC
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4505 HOSPITAL ST STE A
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City | PASCAGOULA
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State | MS
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Zip | 39581-5302
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Country | US
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Telephone | 228-762-1525
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Fax | 228-769-2635
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Provider Business Mailing Address
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Address Line | 4505 HOSPITAL ST STE A
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City | PASCAGOULA
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State | MS
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Zip | 39581-5302
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Country | US
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Telephone | 228-762-1525
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Fax | 228-769-2635
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. BRIAN K SPENCER
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Credential | O.D.
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Telephone | 228-762-1525
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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 | 526 AND 653
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License Number State | MS
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