Organization
PREMIER EYE CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
QING GE M.D., PHD. (PRESIDENT)
(386) 788-6198
Entity
Organization
Contact information
Practice address
3641 SOUTH CLYDE MORRIS BOULEVARD, SUITE 500, PORT ORANGE, FL 32129-2357
(386) 788-6198
(386) 788-4616
Mailing address
3641 SOUTH CLYDE MORRIS BOULEVARD, SUITE 500, PORT ORANGE, FL 32129-2357
(386) 788-6198
(386) 788-4616
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
ME96155
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
277580800
—
FL
Enumeration date
10/27/2011
Last updated
07/10/2012
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