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General NPI Number Information
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NPI Number | 1518224922
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Entity Type | Organization
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Legal Business Name | PREMIER EYE CARE CENTER LLC
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Dates
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Enumeration Date | 04/23/2012
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Last Update Date | 04/16/2021
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Provider Practice Location Address
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Address Line | 12164 CENTRAL AVE STE 220
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City | BOWIE
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State | MD
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Zip | 20721-1903
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Country | US
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Telephone | 301-218-1862
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Fax |
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Provider Business Mailing Address
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Address Line | 12164 CENTRAL AVE STE 220
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City | BOWIE
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State | MD
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Zip | 20721-1903
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Country | US
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Telephone | 301-218-1862
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Fax | 301-218-1864
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Authorized Official
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Title or Position | OWNER
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Name | ESEOSA OMORUYI
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Credential |
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Telephone | 301-218-1862
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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 | TA 2181
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License Number State | MD
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