Provider Demographics
NPI:1962680595
Name:PEARLE VISION RIVERDALE/RELM OPTICIANS,LLC
Entity Type:Organization
Organization Name:PEARLE VISION RIVERDALE/RELM OPTICIANS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MS
Authorized Official - First Name:EMMA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:973-248-1188
Mailing Address - Street 1:92 RTE 23N
Mailing Address - Street 2:SUITE E
Mailing Address - City:RIVERDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07457
Mailing Address - Country:US
Mailing Address - Phone:973-248-1188
Mailing Address - Fax:973-248-1125
Practice Address - Street 1:92 ROUTE 23N
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:NJ
Practice Address - Zip Code:07457
Practice Address - Country:US
Practice Address - Phone:973-248-1188
Practice Address - Fax:973-248-1125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty