Provider Demographics
NPI:1497463350
Name:PEARLE CAPSTONE EYE ASSOCIATES PLLC
Entity Type:Organization
Organization Name:PEARLE CAPSTONE EYE ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CMO
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:PAGE
Authorized Official - Last Name:DICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:616-459-0641
Mailing Address - Street 1:1601 NW EXPRESSWAY STE 1420
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-1460
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:25434 SIERRA CENTER BLVD
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33559-7322
Practice Address - Country:US
Practice Address - Phone:813-452-4442
Practice Address - Fax:813-352-3134
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEARLE CAPSTONE EYE ASSOCIATES PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-11-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty