NPIMap

Organization Active NPI

Premier Eye Clinic

  • Ophthalmology Physician
  • Port Orange, FL
National Provider Identifier
1265718894
Registry record updated Jul 10, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
ME96155 Issued in FL
Legal business name
PREMIER EYE CLINIC
Practice address
3641 South Clyde Morris Boulevard
Suite 500
Port Orange, FL 32129-2357
Phone
(386) 788-6198
Fax
(386) 788-4616
NPI assigned
Oct 27, 2011
Last updated
Jul 10, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 10, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Qing Ge, M.D., PHD.NPI 1225053192
Title
President
Phone
(386) 788-6198

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207W00000X ME96155 FL Primary

Addresses

Primary practice location

3641 South Clyde Morris Boulevard
Suite 500
Port Orange, FL 32129-2357

Mailing address

3641 South Clyde Morris Boulevard
Suite 500
Port Orange, FL 32129-2357
Phone (386) 788-6198

Other identifiers 1

IdentifierTypeStateIssuer
277580800MedicaidFL

National Provider Directory

National Provider Directory
Tax ID family
Premier Eye Clinic2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

  • Qing Ge

    dba Premier Eye Clinic, P. A.

    • Clinic/Center
    • Port Orange, FL
    • NPI 1982898219
    NPD tax ID

Locations

1425 Hand Ave
Ste N
Ormond Beach, FL 32174
Phone (386) 673-3344

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1319673600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1341878400000",
    "number": "1265718894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3641 SOUTH CLYDE MORRIS BOULEVARD",
            "address_2": "SUITE 500",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321292357",
            "telephone_number": "386-788-6198",
            "fax_number": "386-788-4616"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3641 SOUTH CLYDE MORRIS BOULEVARD",
            "address_2": "SUITE 500",
            "city": "PORT ORANGE",
            "state": "FL",
            "postal_code": "321292357",
            "telephone_number": "386-788-6198",
            "fax_number": "386-788-4616"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER EYE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-27",
        "last_updated": "2012-07-10",
        "status": "A",
        "authorized_official_last_name": "GE",
        "authorized_official_first_name": "QING",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "386-788-6198",
        "authorized_official_credential": "M.D., PHD."
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Ophthalmology",
            "state": "FL",
            "license": "ME96155",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "277580800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Orange, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 10, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.