=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851452825
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PREMIER EYE CARE INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/13/2006
-----------------------------------------------------
Last Update Date | 04/04/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 12794 ROYALTON RD
-----------------------------------------------------
City | NORTH ROYALTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44133-4229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-230-4362
-----------------------------------------------------
Fax | 440-230-1350
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12794 ROYALTON RD
-----------------------------------------------------
City | NORTH ROYALTON
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44133-4229
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 440-230-4362
-----------------------------------------------------
Fax | 440-230-1350
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. JOHN MICHAEL PORTER
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 440-230-4362
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 4675 T1450
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------