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General NPI Number Information
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NPI Number | 1205230588
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Entity Type | Organization
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Legal Business Name | PREMIER EYE INSTITUTE, OD, PLLC
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Dates
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Enumeration Date | 10/15/2014
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Last Update Date | 10/05/2015
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Provider Practice Location Address
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Address Line | 2531 E LYON STATION RD SUITE F
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City | CREEDMOOR
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State | NC
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Zip | 27522-9401
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Country | US
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Telephone | 215-880-3817
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Fax |
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Provider Business Mailing Address
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Address Line | 2531 E LYON STATION RD STE F
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City | CREEDMOOR
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State | NC
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Zip | 27522-9401
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Country | US
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Telephone | 215-880-3817
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | NISHA P MEHTA
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Credential | OD
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Telephone | 215-880-3817
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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 | NC2051
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License Number State | NC
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