Provider Demographics
NPI:1760668677
Name:STITH VISION CENTER INC.
Entity Type:Organization
Organization Name:STITH VISION CENTER INC.
Other - Org Name:PEARLE VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TERI
Authorized Official - Middle Name:L
Authorized Official - Last Name:PAGE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:573-686-1164
Mailing Address - Street 1:1916 N WESTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-2808
Mailing Address - Country:US
Mailing Address - Phone:573-686-1164
Mailing Address - Fax:573-686-5072
Practice Address - Street 1:1916 N WESTWOOD BLVD
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-2808
Practice Address - Country:US
Practice Address - Phone:573-686-1164
Practice Address - Fax:573-686-5072
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-10
Last Update Date:2009-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02821152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0661120001Medicare NSC
MOU49744Medicare UPIN
MO990001738Medicare PIN