Provider Demographics
NPI:1528224052
Name:LENSTEK LTD. T/A PEARLE VISION
Entity Type:Organization
Organization Name:LENSTEK LTD. T/A PEARLE VISION
Other - Org Name:LENSTEK LTD. T/A PEARLE VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:EVALENA
Authorized Official - Middle Name:W
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:240-298-0099
Mailing Address - Street 1:PO BOX 278
Mailing Address - Street 2:14455 OAKS ROAD
Mailing Address - City:CHARLOTTE HALL
Mailing Address - State:MD
Mailing Address - Zip Code:20622-0278
Mailing Address - Country:US
Mailing Address - Phone:301-884-2391
Mailing Address - Fax:
Practice Address - Street 1:23191 THREE NOTCH RD
Practice Address - Street 2:
Practice Address - City:CALIFORNIA
Practice Address - State:MD
Practice Address - Zip Code:20619-6024
Practice Address - Country:US
Practice Address - Phone:301-863-6080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization