Premier Eye Care Center LLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

TA 2181 Issued in MD

Legal business name

PREMIER EYE CARE CENTER LLC

Practice address

12164 Central Ave Ste 220
Bowie, MD 20721-1903

Phone

(301) 218-1862

NPI assigned

Apr 23, 2012

Organization subpart

No

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

Authorized official

Name

Eseosa OmoruyiNPI 1811219355

Title

Owner

Phone

(301) 218-1862

Specialties & licenses 1

Addresses

Other names 1

• Premier Eye Care Center LLC Doing business as

Medicare fee-for-service enrollment

Enrolled in DC

Enrollment records 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Eseosa Christine Omoruyi

  • Optometrist
  • Bowie, MD
  • NPI 1811219355

  DC

  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1335139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618531200000",
    "number": "1518224922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12164 CENTRAL AVE STE 220",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "207211903",
            "telephone_number": "301-218-1862",
            "fax_number": "301-218-1864"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12164 CENTRAL AVE STE 220",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "207211903",
            "telephone_number": "301-218-1862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER EYE CARE CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-04-23",
        "last_updated": "2021-04-16",
        "certification_date": "2021-04-16",
        "status": "A",
        "authorized_official_last_name": "OMORUYI",
        "authorized_official_first_name": "ESEOSA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "301-218-1862"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "MD",
            "license": "TA 2181",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Premier Eye Care Center LLC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Optometrist in Bowie, MD
• Providers in Bowie, MD by specialty
• Optometrist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.