Provider Demographics
NPI:1457471864
Name:PEARLE VISION
Entity Type:Organization
Organization Name:PEARLE VISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TATYANA
Authorized Official - Middle Name:
Authorized Official - Last Name:LALANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:847-877-0479
Mailing Address - Street 1:914 N GREEN BAY RD
Mailing Address - Street 2:
Mailing Address - City:WAUKEGAN
Mailing Address - State:IL
Mailing Address - Zip Code:60085-2240
Mailing Address - Country:US
Mailing Address - Phone:847-473-4422
Mailing Address - Fax:847-599-4024
Practice Address - Street 1:914 N GREEN BAY RD
Practice Address - Street 2:
Practice Address - City:WAUKEGAN
Practice Address - State:IL
Practice Address - Zip Code:60085-2240
Practice Address - Country:US
Practice Address - Phone:847-473-4422
Practice Address - Fax:847-599-4024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty