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General NPI Number Information
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NPI Number | 1356546816
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Entity Type | Organization
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Legal Business Name | PREMIER EYECARE, PLLC
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Dates
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Enumeration Date | 06/15/2007
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Last Update Date | 08/24/2007
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Provider Practice Location Address
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Address Line | 11121 KINGSTON PIKE SUITE A
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City | KNOXVILLE
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State | TN
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Zip | 37934-2890
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Country | US
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Telephone | 865-966-0100
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Fax | 865-966-0007
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Provider Business Mailing Address
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Address Line | 11121 KINGSTON PIKE SUITE A
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City | KNOXVILLE
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State | TN
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Zip | 37934-2890
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Country | US
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Telephone | 865-966-0100
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Fax | 865-966-0007
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRENT B FRY
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Credential | O.D.
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Telephone | 865-966-0100
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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 | TNOD1904
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License Number State | TN
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