Provider Demographics
NPI:1942394028
Name:PREMIER EYE CARE, PLLC
Entity type:Organization
Organization Name:PREMIER EYE CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:SIMON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-744-3937
Mailing Address - Street 1:225 HOSPITAL DR STE 160
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-7635
Mailing Address - Country:US
Mailing Address - Phone:859-744-3937
Mailing Address - Fax:859-744-3941
Practice Address - Street 1:225 HOSPITAL DR STE 160
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-7635
Practice Address - Country:US
Practice Address - Phone:859-744-3937
Practice Address - Fax:859-744-3941
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER EYE CARE, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-03
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY29402207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65926727Medicaid