Provider Demographics
NPI:1346305323
Name:PEARLE VISIONCARE, INC
Entity Type:Organization
Organization Name:PEARLE VISIONCARE, INC
Other - Org Name:PEARLE VISION #C6010
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICARE SUPERVISOR
Authorized Official - Prefix:MS
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 1:1350 TRAVIS BLVD
Mailing Address - Street 2:SOLANO MALL STE 1524B
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-4646
Mailing Address - Country:US
Mailing Address - Phone:707-422-0856
Mailing Address - Fax:
Practice Address - Street 1:1350 TRAVIS BLVD
Practice Address - Street 2:SOLANO MALL STE 1524B
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-4646
Practice Address - Country:US
Practice Address - Phone:707-422-0856
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0132600113Medicare NSC