Provider Demographics
NPI:1043454465
Name:SUPERIOR EYES CORP
Entity Type:Organization
Organization Name:SUPERIOR EYES CORP
Other - Org Name:PEARLE VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DARY
Authorized Official - Middle Name:
Authorized Official - Last Name:PRUPES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-656-0440
Mailing Address - Street 1:5860 N. TARRANT PKWY.
Mailing Address - Street 2:STE. 108
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244
Mailing Address - Country:US
Mailing Address - Phone:817-656-0440
Mailing Address - Fax:817-428-4262
Practice Address - Street 1:5860 N. TARRANT PKWY.
Practice Address - Street 2:STE. 108
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244
Practice Address - Country:US
Practice Address - Phone:817-656-0440
Practice Address - Fax:817-428-4262
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-29
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization