Provider Demographics
NPI:1740345081
Name:PEARLE VISION INC
Entity type:Organization
Organization Name:PEARLE VISION INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICARE SUPERVISOR
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 1:2284 S BALLENGER HWY
Mailing Address - Street 2:BALLENGER POINTE
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48503-3446
Mailing Address - Country:US
Mailing Address - Phone:810-767-4020
Mailing Address - Fax:810-767-6982
Practice Address - Street 1:2284 S BALLENGER HWY
Practice Address - Street 2:BALLENGER POINTE
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48503-3446
Practice Address - Country:US
Practice Address - Phone:810-767-4020
Practice Address - Fax:810-767-6982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0132600578Medicare ID - Type Unspecified