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General NPI Number Information
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NPI Number | 1386768810
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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 | 03/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4551 GAUTIER VANCLEAVE RD
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City | GAUTIER
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State | MS
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Zip | 39553-4810
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Country | US
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Telephone | 228-497-5126
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Fax | 228-497-5156
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Provider Business Mailing Address
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Address Line | 4551 GAUTIER VANCLEAVE RD
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City | GAUTIER
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State | MS
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Zip | 39553-4810
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Country | US
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Telephone | 228-497-5126
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Fax | 228-497-5156
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Authorized Official
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Title or Position | CO-OWNER
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Name | DR. BRIAN L HUNT
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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
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 653
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License Number State | MS
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