Provider Demographics
NPI:1609976992
Name:PEARL, JAMES R (OD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:R
Last Name:PEARL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9391 OLDE EIGHT RD.
Mailing Address - Street 2:P.O. BOX 254
Mailing Address - City:NORTHFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44067-1953
Mailing Address - Country:US
Mailing Address - Phone:330-467-7600
Mailing Address - Fax:330-468-3937
Practice Address - Street 1:9391 OLDE 8 RD
Practice Address - Street 2:
Practice Address - City:NORTHFIELD
Practice Address - State:OH
Practice Address - Zip Code:44067-1953
Practice Address - Country:US
Practice Address - Phone:330-467-7600
Practice Address - Fax:330-468-3937
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2800/T594152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHT46647Medicare UPIN
OHPEO397732Medicare ID - Type Unspecified
OH0386720001Medicare NSC