Provider Demographics
NPI:1457491508
Name:PEARLE VISION INC
Entity Type:Organization
Organization Name:PEARLE VISION INC
Other - Org Name:
Other - Org Type:
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 1:4359 WESTLAND MALL
Mailing Address - Street 2:SP. C26
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-1628
Mailing Address - Country:US
Mailing Address - Phone:614-351-5252
Mailing Address - Fax:614-351-5254
Practice Address - Street 1:4359 WESTLAND MALL
Practice Address - Street 2:SP. C26
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-1628
Practice Address - Country:US
Practice Address - Phone:614-351-5252
Practice Address - Fax:614-351-5254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0168849Medicaid