Provider Demographics
NPI:1235167487
Name:PEARSON, MIRIAM E (OD)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:E
Last Name:PEARSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 617
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19543-0617
Mailing Address - Country:US
Mailing Address - Phone:610-286-0206
Mailing Address - Fax:610-286-5525
Practice Address - Street 1:105 MOREVIEW BLVD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:PA
Practice Address - Zip Code:19543-9483
Practice Address - Country:US
Practice Address - Phone:610-286-0206
Practice Address - Fax:610-286-5525
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000809152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
584021OtherHIGHMARK BLUE SHIELD
01942101OtherCAPITAL BLUE SHIELD
542780OtherAETNA
584021OtherHIGHMARK BLUE SHIELD
U06575Medicare UPIN
PA548021Medicare PIN