Provider Demographics
NPI:1568685790
Name:PEARLE VISION
Entity Type:Organization
Organization Name:PEARLE VISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOE
Authorized Official - Middle Name:
Authorized Official - Last Name:ZWEBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-752-4468
Mailing Address - Street 1:20 N MAIN ST STE B13
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-4080
Mailing Address - Country:US
Mailing Address - Phone:406-752-4468
Mailing Address - Fax:
Practice Address - Street 1:20 N MAIN ST STE B13
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-4080
Practice Address - Country:US
Practice Address - Phone:406-752-4468
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0550706Medicaid
MT0550706Medicaid