Provider Demographics
NPI:1184789166
Name:PEARLE VISIONCARE INC
Entity type:Organization
Organization Name:PEARLE VISIONCARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICARE ADMINISTRATOR
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 1:5308 PACIFIC AVE
Mailing Address - Street 2:SHERWOOD MALL
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5619
Mailing Address - Country:US
Mailing Address - Phone:209-952-1701
Mailing Address - Fax:
Practice Address - Street 1:5308 PACIFIC AVE
Practice Address - Street 2:SHERWOOD MALL
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5619
Practice Address - Country:US
Practice Address - Phone:209-952-1701
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0132600060Medicare NSC