Provider Demographics
NPI:1083778666
Name:PEARLE VISION INC
Entity Type:Organization
Organization Name:PEARLE VISION INC
Other - Org Name:PEARLE VISION #C6308
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICARE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:UHLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-765-3534
Mailing Address - Street 1:750 CITADEL DR E
Mailing Address - Street 2:THE CITADEL
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80909-5327
Mailing Address - Country:US
Mailing Address - Phone:719-550-0300
Mailing Address - Fax:
Practice Address - Street 1:750 CITADEL DR E
Practice Address - Street 2:THE CITADEL
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-5327
Practice Address - Country:US
Practice Address - Phone:719-550-0300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO0132600315Medicare NSC