Provider Demographics
NPI:1538161989
Name:PREMIER EYE CARE GROUP, INC.
Entity type:Organization
Organization Name:PREMIER EYE CARE GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GEOFFREY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:BRENT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-232-2245
Mailing Address - Street 1:92 TUSCARORA ST
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1667
Mailing Address - Country:US
Mailing Address - Phone:717-232-0843
Mailing Address - Fax:717-232-2215
Practice Address - Street 1:3903 HARTZDALE DR
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011
Practice Address - Country:US
Practice Address - Phone:717-761-3077
Practice Address - Fax:717-761-1186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-15
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000093152W00000X
PA6000004226332B00000X
PAMD020133E207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA756393OtherHIGHMARK BLUE SHIELD
PA747187OtherHIGHMARK BS
PA01823136Medicaid
PA01471368Medicaid
PA2276000OtherCAPITAL BC
PA756393OtherHIGHMARK BLUE SHIELD
PA0664300003Medicare NSC
PA0664300001Medicare NSC