Provider Demographics
NPI:1679624621
Name:VISUAL EDGE, INC
Entity Type:Organization
Organization Name:VISUAL EDGE, INC
Other - Org Name:PEARLE VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:ZWEBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-345-5044
Mailing Address - Street 1:1405 MILLER TRUNK HWY
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55811
Mailing Address - Country:US
Mailing Address - Phone:218-722-7843
Mailing Address - Fax:218-722-6436
Practice Address - Street 1:1405 MILLER TRUNK HWY
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55811
Practice Address - Country:US
Practice Address - Phone:218-722-7843
Practice Address - Fax:218-722-6436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1068294156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN183M1PEOtherBCBS EYEWEAR
MN182M9PEOtherBCBS VISION EXAMS
MN0626900008OtherMEDICARE DMERC REGION B
MN21-22995OtherMEDICA-UHC
MN182M9PEOtherBCBS VISION EXAMS