Provider Demographics
NPI:1174294870
Name:PEARL EYECARE CENTER P S
Entity Type:Organization
Organization Name:PEARL EYECARE CENTER P S
Other - Org Name:PUYALLUP VISION SOURCE PS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:NOBLE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:253-472-1188
Mailing Address - Street 1:5016 BRIDGEPORT WAY W
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98467-2039
Mailing Address - Country:US
Mailing Address - Phone:235-472-1188
Mailing Address - Fax:
Practice Address - Street 1:113 W PIONEER
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-5373
Practice Address - Country:US
Practice Address - Phone:253-845-8215
Practice Address - Fax:253-845-7030
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEARL EYECARE CENTER P S
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-22
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty