Provider Demographics
NPI:1174687354
Name:PEARLE VISION INC
Entity Type:Organization
Organization Name:PEARLE VISION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICARE SUPERVISOR
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 1:3601 CONSTITUTION BLVD
Mailing Address - Street 2:VALLEY FAIR MALL
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84119-3746
Mailing Address - Country:US
Mailing Address - Phone:801-967-9048
Mailing Address - Fax:801-967-2733
Practice Address - Street 1:3601 CONSTITUTION BLVD
Practice Address - Street 2:VALLEY FAIR MALL
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84119-3746
Practice Address - Country:US
Practice Address - Phone:801-967-9048
Practice Address - Fax:801-967-2733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT0132600169Medicare ID - Type Unspecified