Provider Demographics
NPI:1699978478
Name:PREMIUM EYECARE PLLC
Entity type:Organization
Organization Name:PREMIUM EYECARE PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:THERAPEUTIC OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:UKWADE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-488-4774
Mailing Address - Street 1:2402 BAY AREA BLVD
Mailing Address - Street 2:STE. F
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-1565
Mailing Address - Country:US
Mailing Address - Phone:281-488-4774
Mailing Address - Fax:281-488-4775
Practice Address - Street 1:2402 BAY AREA BLVD
Practice Address - Street 2:STE. F
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058-1565
Practice Address - Country:US
Practice Address - Phone:281-488-4774
Practice Address - Fax:281-488-4775
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
54199OtherDAVIS VISION
26172OtherSPECTERA
0018FEOtherBLUECROSS BLUESHIELD
TX4037OtherEYEMED
54199OtherDAVIS VISION