Provider Demographics
NPI:1932363934
Name:PREMIER EYE CARE OF FLORIDA LLC
Entity type:Organization
Organization Name:PREMIER EYE CARE OF FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:PANOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-455-9002
Mailing Address - Street 1:PO BOX 21503
Mailing Address - Street 2:
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55121-0503
Mailing Address - Country:US
Mailing Address - Phone:561-455-9002
Mailing Address - Fax:800-523-3788
Practice Address - Street 1:2001 S ANDREWS AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-3429
Practice Address - Country:US
Practice Address - Phone:561-455-9002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-18
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL125168900Medicaid