Provider Demographics
NPI:1821139643
Name:SUPERIOR VISION LLC
Entity Type:Organization
Organization Name:SUPERIOR VISION LLC
Other - Org Name:PEARLE VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SVETLANA
Authorized Official - Middle Name:
Authorized Official - Last Name:RONIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-685-7200
Mailing Address - Street 1:1301 W GLADE RD STE 196
Mailing Address - Street 2:
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76039-5419
Mailing Address - Country:US
Mailing Address - Phone:817-685-7200
Mailing Address - Fax:817-685-7211
Practice Address - Street 1:1301 W GLADE RD STE 196
Practice Address - Street 2:
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76039-5419
Practice Address - Country:US
Practice Address - Phone:817-685-7200
Practice Address - Fax:817-685-7211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
4563910001Medicare NSC