Provider Demographics
NPI:1902017460
Name:PEARLE VISION EXPRESS
Entity Type:Organization
Organization Name:PEARLE VISION EXPRESS
Other - Org Name:VISION HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:
Authorized Official - Last Name:TREPETIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-722-6222
Mailing Address - Street 1:2827 RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:ROCKWALL
Mailing Address - State:TX
Mailing Address - Zip Code:75032-5528
Mailing Address - Country:US
Mailing Address - Phone:972-722-6222
Mailing Address - Fax:
Practice Address - Street 1:2827 RIDGE RD
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75032-5528
Practice Address - Country:US
Practice Address - Phone:972-722-6222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA693214156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty