Provider Demographics
NPI:1659582492
Name:PEARLE VISION
Entity Type:Organization
Organization Name:PEARLE VISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LUBOV
Authorized Official - Middle Name:
Authorized Official - Last Name:NASCIMENTO
Authorized Official - Suffix:
Authorized Official - Credentials:RDO #5548
Authorized Official - Phone:617-923-2022
Mailing Address - Street 1:57 THORNDIKE ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-2405
Mailing Address - Country:US
Mailing Address - Phone:617-272-6298
Mailing Address - Fax:
Practice Address - Street 1:485 ARSENAL ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-5091
Practice Address - Country:US
Practice Address - Phone:617-923-2022
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332900000XSuppliersNon-Pharmacy Dispensing Site
Not Answered332H00000XSuppliersEyewear Supplier