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Organization
PREMIER VISION LLC
Active
Organization
PREMIER VISION LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTINE THAO SAM OD (PROVIDER - OWNER)
(504) 234-5678
Entity
Organization
Contact information
Practice address
703 N MAIN ST, KISSIMMEE, FL 34744-5265
(504) 234-5678
Mailing address
3601 VALLEYVIEW DR, KISSIMMEE, FL 34746-2895
(504) 234-5678
(407) 350-5883
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPC5446
FL
Other
Enumeration date
12/27/2017
Last updated
12/27/2017
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