Provider Demographics
NPI:1255468930
Name:PBW OPTOMETRY P C
Entity Type:Organization
Organization Name:PBW OPTOMETRY P C
Other - Org Name:RIVERVIEW VISION AND LASER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:PEARL
Authorized Official - Suffix:
Authorized Official - Credentials:O D
Authorized Official - Phone:602-524-7618
Mailing Address - Street 1:2215 HUALAPAI MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-8324
Mailing Address - Country:US
Mailing Address - Phone:928-718-1009
Mailing Address - Fax:
Practice Address - Street 1:2215 HUALAPAI MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:KINGMAN
Practice Address - State:AZ
Practice Address - Zip Code:86401-8324
Practice Address - Country:US
Practice Address - Phone:928-718-1009
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ178152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty