MEDICARE: PREMIER VISUAL HEALTH, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	ME86805	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1265797138
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER VISUAL HEALTH, LLC

Provider Business Mailing Address
First Line	:	810 N ROSE AVE
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34741-4944
Country	:	US
Telephone Number	:	407-352-4044
Fax Number	:	407-352-4043

Provider Business Practice Location Address
First Line	:	810 N ROSE AVE
Second Line	:
City	:	KISSIMMEE
State	:	FL
Zip	:	34741-4944
Country	:	US
Telephone Number	:	407-352-4044
Fax Number	:	407-352-4043

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	MS. JUANA P CETINA
Credential	:
Telephone Number	:	407-352-4044

Provider Enumeration Date	:	07/06/2012
Last Update Date	:	11/19/2015

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Directions to “PREMIER VISUAL HEALTH, LLC ” Practice Location

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