Provider Demographics
NPI:1063648558
Name:ACCLARO OPTICAL INC.
Entity Type:Organization
Organization Name:ACCLARO OPTICAL INC.
Other - Org Name:PEARLE VISION BUNKER HILL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NADIA
Authorized Official - Middle Name:
Authorized Official - Last Name:SLEDGE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:713-623-4181
Mailing Address - Street 1:5015 WESTHEIMER RD
Mailing Address - Street 2:SUITE 2304
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77056-5621
Mailing Address - Country:US
Mailing Address - Phone:713-623-4181
Mailing Address - Fax:713-623-8429
Practice Address - Street 1:9738 KATY FWY
Practice Address - Street 2:SUITE 500
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77055-6209
Practice Address - Country:US
Practice Address - Phone:713-468-2424
Practice Address - Fax:713-468-3246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-10
Last Update Date:2009-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5361TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OA3756Medicare PIN