Provider Demographics
NPI:1467137000
Name:PEARL OPTOMETRY
Entity Type:Organization
Organization Name:PEARL OPTOMETRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:BRISOL
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTRADA-VALENZUELA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-405-9813
Mailing Address - Street 1:PO BOX 17
Mailing Address - Street 2:
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-0017
Mailing Address - Country:US
Mailing Address - Phone:562-405-9813
Mailing Address - Fax:
Practice Address - Street 1:12324 HOXIE AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-2211
Practice Address - Country:US
Practice Address - Phone:562-929-4499
Practice Address - Fax:562-929-7977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-20
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty