Provider Demographics
NPI:1174688188
Name:PEARLE VISIONCARE, INC
Entity Type:Organization
Organization Name:PEARLE VISIONCARE, INC
Other - Org Name:PEARLE VISION #C6025
Other - Org Type:Doing Business As
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 1:1620 SARATOGA AVE
Mailing Address - Street 2:WESTGATE S/C #P-301
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95129-5113
Mailing Address - Country:US
Mailing Address - Phone:408-374-1001
Mailing Address - Fax:
Practice Address - Street 1:1620 SARATOGA AVE
Practice Address - Street 2:WESTGATE S/C #P-301
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95129-5113
Practice Address - Country:US
Practice Address - Phone:408-374-1001
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0132600437Medicare NSC