Provider Demographics
NPI:1063640712
Name:AMO, INC/PEARLE VISION
Entity Type:Organization
Organization Name:AMO, INC/PEARLE VISION
Other - Org Name:PEARLE VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FRANCHISE OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ALINA
Authorized Official - Middle Name:MARIA
Authorized Official - Last Name:LUCCIO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:617-678-9726
Mailing Address - Street 1:100 CITY HALL PLZ
Mailing Address - Street 2:SEARS CRESCENT BUILDING
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02108-2105
Mailing Address - Country:US
Mailing Address - Phone:617-367-2020
Mailing Address - Fax:
Practice Address - Street 1:100 CITY HALL PLZ
Practice Address - Street 2:SEARS CRESCENT BUILDING
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02108-2105
Practice Address - Country:US
Practice Address - Phone:617-367-2020
Practice Address - Fax:617-523-7040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA4389156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty