1740201482 NPI number — PREMIERE EYE ASSOCIATES, P.C.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740201482 NPI number — PREMIERE EYE ASSOCIATES, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREMIERE EYE ASSOCIATES, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1740201482
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/06/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 13
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CRYSTAL CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63019-0013
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
636-937-8855
Provider Business Mailing Address Fax Number:
636-931-6561

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 HWY 61 SOUTH
Provider Second Line Business Practice Location Address:
SUITE 130
Provider Business Practice Location Address City Name:
CRYSTAL CITY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-937-8855
Provider Business Practice Location Address Fax Number:
636-931-6561
Provider Enumeration Date:
07/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SPURRIER
Authorized Official First Name:
MARK
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
636-937-8855

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 156FX1800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0695040001 . This is a "NORIDIAN DME MAC" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: CN1852 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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