Provider Demographics
NPI:1982853644
Name:PEARLE VISION CENTER
Entity Type:Organization
Organization Name:PEARLE VISION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GOUGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-547-8642
Mailing Address - Street 1:1726 RAINBOW DR STE A
Mailing Address - Street 2:
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35901-5555
Mailing Address - Country:US
Mailing Address - Phone:256-547-8642
Mailing Address - Fax:256-547-3135
Practice Address - Street 1:1726 RAINBOW DR STE A
Practice Address - Street 2:
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35901-5555
Practice Address - Country:US
Practice Address - Phone:256-547-8642
Practice Address - Fax:256-547-3135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-17
Last Update Date:2008-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALT88022332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier