Provider Demographics
NPI:1538295985
Name:NATIELLA, INC
Entity Type:Organization
Organization Name:NATIELLA, INC
Other - Org Name:PEARLE VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:S
Authorized Official - Last Name:OUIMET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:508-761-6000
Mailing Address - Street 1:1230 NEWPORT AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-8004
Mailing Address - Country:US
Mailing Address - Phone:508-761-6000
Mailing Address - Fax:508-761-5555
Practice Address - Street 1:1230 NEWPORT AVE
Practice Address - Street 2:
Practice Address - City:SOUTH ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-8004
Practice Address - Country:US
Practice Address - Phone:508-761-6000
Practice Address - Fax:508-761-5555
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:YES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1537318Medicaid
MA1537318Medicaid