Provider Demographics
NPI:1871765909
Name:PREMIER EYE GROUP, INC.
Entity type:Organization
Organization Name:PREMIER EYE GROUP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:K
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:O D
Authorized Official - Phone:615-355-6677
Mailing Address - Street 1:1610 ROCK SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-6177
Mailing Address - Country:US
Mailing Address - Phone:615-355-6677
Mailing Address - Fax:615-355-6670
Practice Address - Street 1:1610 ROCK SPRINGS RD
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-6177
Practice Address - Country:US
Practice Address - Phone:615-355-6677
Practice Address - Fax:615-355-6670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-28
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN 2188152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3644289Medicaid
TN3944289Medicare PIN
TN3644289Medicaid