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General NPI Number Information
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NPI Number | 1942394028
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Entity Type | Organization
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Legal Business Name | PREMIER EYE CARE, PLLC
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 07/11/2022
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Provider Practice Location Address
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Address Line | 225 HOSPITAL DR STE 160
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City | WINCHESTER
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State | KY
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Zip | 40391-7635
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Country | US
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Telephone | 859-744-3937
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Fax | 859-744-3941
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Provider Business Mailing Address
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Address Line | 225 HOSPITAL DR STE 160
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City | WINCHESTER
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State | KY
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Zip | 40391-7635
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Country | US
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Telephone | 859-744-3937
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Fax | 859-744-3941
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Authorized Official
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Title or Position | OWNER
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Name | MARK SIMON
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Credential | MD
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Telephone | 859-744-3937
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 29402
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License Number State | KY
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