Provider Demographics
NPI: | 1154441756 |
---|---|
Name: | GERVAIS-FLOYD, LTD |
Entity Type: | Organization |
Organization Name: | GERVAIS-FLOYD, LTD |
Other - Org Name: | PEARLE VISION |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | JENNIFER |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | SULLIVAN |
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: | 2007-03-29 |
Last Update Date: | 2013-09-01 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 152W00000X | Eye and Vision Services Providers | Optometrist | Group - Multi-Specialty | |
No | 332H00000X | Suppliers | Eyewear Supplier | Group - Multi-Specialty |