Organization
MOMPREMIER EYE INSTITUTE, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MIKELSON MOMPREMIER MD, FACS (PRESIDENT/CEO)
(469) 687-5664
Entity
Organization
Contact information
Practice address
1510 N HAMPTON RD, SUITE 290, DESOTO, TX 75115-8300
(954) 302-7657
Mailing address
1510 N HAMPTON RD, SUITE 290, DESOTO, TX 75115-8300
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
P7164
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
323540001
—
TX
Enumeration date
09/21/2016
Last updated
02/13/2018
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