Provider Demographics
NPI:1518037589
Name:PEARLE VISION
Entity Type:Organization
Organization Name:PEARLE VISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STORE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:S
Authorized Official - Last Name:VARNER
Authorized Official - Suffix:
Authorized Official - Credentials:ABOC
Authorized Official - Phone:319-752-6378
Mailing Address - Street 1:550 S GEAR AVE
Mailing Address - Street 2:SUITE 31
Mailing Address - City:WEST BURLINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52655-1044
Mailing Address - Country:US
Mailing Address - Phone:319-752-6378
Mailing Address - Fax:319-752-2589
Practice Address - Street 1:550 S GEAR AVE
Practice Address - Street 2:SUITE 31
Practice Address - City:WEST BURLINGTON
Practice Address - State:IA
Practice Address - Zip Code:52655-1044
Practice Address - Country:US
Practice Address - Phone:319-752-6378
Practice Address - Fax:319-752-2589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0206375Medicaid