Organization
PREMIUM EYECARE, LTD.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JIRASAN SAKULSOM OD (PRESIDENT)
(636) 675-9167
Entity
Organization
Contact information
Practice address
215 W 23RD ST, CHICAGO, IL 60616-1903
(312) 225-3188
(312) 225-9188
Mailing address
2025 S INDIANA AVE, APT 202, CHICAGO, IL 60616-4926
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046010489
IL
Other
Enumeration date
09/20/2013
Last updated
09/20/2013
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