Provider Demographics
NPI:1437362605
Name:SCOTT M PEARL OD PA
Entity Type:Organization
Organization Name:SCOTT M PEARL OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:M
Authorized Official - Last Name:PEARL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:954-430-8330
Mailing Address - Street 1:18503 PINES BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33029-1404
Mailing Address - Country:US
Mailing Address - Phone:954-430-8330
Mailing Address - Fax:
Practice Address - Street 1:18503 PINES BLVD
Practice Address - Street 2:SUITE 205
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33029-1404
Practice Address - Country:US
Practice Address - Phone:954-430-8330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-07
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1954152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL084946400Medicaid
FLAE515Medicare PIN