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General NPI Number Information
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NPI Number | 1376213165
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Entity Type | Organization
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Legal Business Name | PREMIER VISION PARTNERS
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Dates
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Enumeration Date | 09/14/2021
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Last Update Date | 09/14/2021
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Provider Practice Location Address
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Address Line | 5391 HIGHWAY 53 STE 102
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City | BRASELTON
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State | GA
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Zip | 30517-3136
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Country | US
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Telephone | 706-658-0270
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Fax |
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Provider Business Mailing Address
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Address Line | 279 N BROAD ST STE C
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City | WINDER
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State | GA
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Zip | 30680-2589
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Country | US
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Telephone | 770-867-2505
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Fax |
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | DARRELL SORAH
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Credential | OD
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Telephone | 706-658-0270
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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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