Provider Demographics
NPI:1760547731
Name:PEARLE VISIONCARE, INC
Entity Type:Organization
Organization Name:PEARLE VISIONCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICARE SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:UHLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-765-3534
Mailing Address - Street 1:4595 CLAIREMONT DR
Mailing Address - Street 2:CLAIREMONT
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-5540
Mailing Address - Country:US
Mailing Address - Phone:858-272-1051
Mailing Address - Fax:858-272-7466
Practice Address - Street 1:4595 CLAIREMONT DR
Practice Address - Street 2:CLAIREMONT
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-5540
Practice Address - Country:US
Practice Address - Phone:858-272-1051
Practice Address - Fax:858-272-7466
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0132600006Medicare ID - Type Unspecified