# PREMIER EYE CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1265718894
- **Authorized official:** QING GE M.D., PHD. (PRESIDENT)
- **Authorized official phone:** (386) 788-6198

## Contact information

- **Practice address:** 3641 SOUTH CLYDE MORRIS BOULEVARD, SUITE 500, PORT ORANGE, FL 32129-2357
- **Practice address phone:** (386) 788-6198
- **Practice address fax:** (386) 788-4616
- **Mailing address:** 3641 SOUTH CLYDE MORRIS BOULEVARD, SUITE 500, PORT ORANGE, FL 32129-2357
- **Mailing address phone:** (386) 788-6198
- **Mailing address fax:** (386) 788-4616

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207W00000X | Ophthalmology Physician | ME96155 | FL | Yes |

## Other

- **Enumeration date:** 10/27/2011
- **Last updated:** 07/10/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 277580800 | — | FL |