Provider Demographics
NPI:1790840353
Name:PEARLE VISION INC
Entity Type:Organization
Organization Name:PEARLE VISION 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:OLD STATE ROAD
Mailing Address - Street 2:BERKSHIRE MALL
Mailing Address - City:LANESBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01237-9500
Mailing Address - Country:US
Mailing Address - Phone:413-448-2740
Mailing Address - Fax:413-443-0017
Practice Address - Street 1:OLD STATE ROAD
Practice Address - Street 2:BERKSHIRE MALL
Practice Address - City:LANESBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01237-9500
Practice Address - Country:US
Practice Address - Phone:413-448-2740
Practice Address - Fax:413-443-0017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0132600485Medicare ID - Type Unspecified