Provider Demographics
NPI:1508919713
Name:PEARLE VISION CENTER OF PUERTO RICO, INC
Entity Type:Organization
Organization Name:PEARLE VISION CENTER OF PUERTO RICO, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICARE SUPERVISOR
Authorized Official - Prefix:MS
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:PLAZA VEGA BAJA
Mailing Address - Street 2:PLAZA VEGA BAJA
Mailing Address - City:VEGA BAJA
Mailing Address - State:PR
Mailing Address - Zip Code:00693
Mailing Address - Country:US
Mailing Address - Phone:787-858-6567
Mailing Address - Fax:787-858-6400
Practice Address - Street 1:PLAZA VEGA BAJA
Practice Address - Street 2:PLAZA VEGA BAJA
Practice Address - City:VEGA BAJA
Practice Address - State:PR
Practice Address - Zip Code:00693
Practice Address - Country:US
Practice Address - Phone:787-858-6567
Practice Address - Fax:787-858-6400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier