Provider Demographics
NPI:1225189848
Name:VISUAL EDGE, INC
Entity Type:Organization
Organization Name:VISUAL EDGE, INC
Other - Org Name:PEARLE VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:ZWEBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-345-5044
Mailing Address - Street 1:111 S 24TH ST W
Mailing Address - Street 2:RIMROCK MINI MALL
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-5600
Mailing Address - Country:US
Mailing Address - Phone:406-656-2006
Mailing Address - Fax:406-655-0460
Practice Address - Street 1:111 S 24TH ST W
Practice Address - Street 2:RIMROCK MINI MALL
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-5600
Practice Address - Country:US
Practice Address - Phone:406-656-2006
Practice Address - Fax:406-655-0460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT0145852156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0551161Medicaid
MT0626900002OtherMEDICARE DMERC REGION D