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General NPI Number Information
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NPI Number | 1932591682
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Entity Type | Organization
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Legal Business Name | PREMIER EYES
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Dates
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Enumeration Date | 03/03/2015
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Last Update Date | 03/25/2020
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Provider Practice Location Address
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Address Line | 13965 W BURLEIGH RD STE 108
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City | BROOKFIELD
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State | WI
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Zip | 53005-3074
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Country | US
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Telephone | 262-505-5440
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Fax | 262-505-5414
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Provider Business Mailing Address
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Address Line | 13965 W BURLEIGH RD STE 108
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City | BROOKFIELD
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State | WI
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Zip | 53005-3074
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Country | US
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Telephone | 262-505-5440
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Fax | 262-505-5414
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. BRYAN A BELL
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Credential | OD
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Telephone | 262-505-5440
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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 | 3010
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License Number State | WI
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