Provider Demographics
NPI:1598755589
Name:PELLEGRINE, INC DBA PEARLE VISION
Entity Type:Organization
Organization Name:PELLEGRINE, INC DBA PEARLE VISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:PELLEGRINE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:314-997-1377
Mailing Address - Street 1:11533 OLIVE BLVD
Mailing Address - Street 2:
Mailing Address - City:CREVE COEUR
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7110
Mailing Address - Country:US
Mailing Address - Phone:314-997-1377
Mailing Address - Fax:314-997-1378
Practice Address - Street 1:11533 OLIVE BLVD
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141-7110
Practice Address - Country:US
Practice Address - Phone:314-997-1377
Practice Address - Fax:314-997-1378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO14800888156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty