Provider Demographics
NPI:1336596659
Name:ROCKWALL VISION SERVICES
Entity Type:Organization
Organization Name:ROCKWALL VISION SERVICES
Other - Org Name:PEARLE VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALEX
Authorized Official - Middle Name:M
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:2016-05-17
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8436OtherEYEWEAR SALES