Provider Demographics
NPI:1073758140
Name:GERVAIS FLOYD
Entity Type:Organization
Organization Name:GERVAIS FLOYD
Other - Org Name:PEARLE VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUMEISTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-403-3555
Mailing Address - Street 1:24 ORLAND SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-3207
Mailing Address - Country:US
Mailing Address - Phone:708-403-3555
Mailing Address - Fax:
Practice Address - Street 1:24 ORLAND SQUARE DR
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-3207
Practice Address - Country:US
Practice Address - Phone:708-403-3555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-03
Last Update Date:2024-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier