Provider Demographics
NPI:1134287618
Name:PEARLE VISION
Entity Type:Organization
Organization Name:PEARLE VISION
Other - Org Name:TONE OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTICAN OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:TARASOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:518-458-2112
Mailing Address - Street 1:971 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-3503
Mailing Address - Country:US
Mailing Address - Phone:518-458-2112
Mailing Address - Fax:518-458-2870
Practice Address - Street 1:971 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12205-3503
Practice Address - Country:US
Practice Address - Phone:518-458-2112
Practice Address - Fax:518-458-2870
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-05
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC004068-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0860250001Medicare ID - Type UnspecifiedDURABLE MEDICAL HARDWARE