Provider Demographics
NPI:1255471280
Name:PEARLE VISION INC
Entity Type:Organization
Organization Name:PEARLE VISION INC
Other - Org Name:PEARLE VISION #C6664
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICARE SUPERVISOR
Authorized Official - Prefix:
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 1:6420 MAYFIELD RD
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124
Mailing Address - Country:US
Mailing Address - Phone:440-449-7464
Mailing Address - Fax:
Practice Address - Street 1:6420 MAYFIELD RD
Practice Address - Street 2:
Practice Address - City:MAYFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44124
Practice Address - Country:US
Practice Address - Phone:440-449-7464
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0132600648Medicare NSC