Provider Demographics
NPI:1205025962
Name:PEARL OPTICAL INC P S
Entity Type:Organization
Organization Name:PEARL OPTICAL INC P S
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:NOBLE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:206-246-5430
Mailing Address - Street 1:407 BAKER BLVD
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98188-2906
Mailing Address - Country:US
Mailing Address - Phone:206-246-5430
Mailing Address - Fax:206-246-7826
Practice Address - Street 1:407 BAKER BLVD
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2906
Practice Address - Country:US
Practice Address - Phone:206-246-5430
Practice Address - Fax:206-246-7826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-18
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1426TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG217112300OtherOLD PIN
WAG217112300OtherOLD PIN