Provider Demographics
NPI:1639232838
Name:PEARL, GREG (OD)
Entity Type:Individual
Prefix:DR
First Name:GREG
Middle Name:
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 1:12324 HOXIE AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-2211
Mailing Address - Country:US
Mailing Address - Phone:562-405-9813
Mailing Address - Fax:323-651-1426
Practice Address - Street 1:12324 HOXIE AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-2211
Practice Address - Country:US
Practice Address - Phone:562-929-4499
Practice Address - Fax:562-929-7977
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2023-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7764152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist