Provider Demographics
NPI:1386867257
Name:PEARSON EYECARE GROUP, LLC
Entity Type:Organization
Organization Name:PEARSON EYECARE GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:KERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:PEARSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:480-345-7520
Mailing Address - Street 1:6555 E SOUTHERN AVE
Mailing Address - Street 2:#1508
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-3724
Mailing Address - Country:US
Mailing Address - Phone:480-890-0618
Mailing Address - Fax:480-462-0121
Practice Address - Street 1:1649 S STAPLEY DR
Practice Address - Street 2:#108
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85204-6649
Practice Address - Country:US
Practice Address - Phone:480-345-7520
Practice Address - Fax:480-844-8699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ61024Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER