Provider Demographics
NPI:1932347127
Name:PEARLE VISION CENTER
Entity Type:Organization
Organization Name:PEARLE VISION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FRANCHISEE
Authorized Official - Prefix:MR
Authorized Official - First Name:SAMIR
Authorized Official - Middle Name:G
Authorized Official - Last Name:RIZK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-490-6030
Mailing Address - Street 1:14811 BALTIMORE AVE
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-4817
Mailing Address - Country:US
Mailing Address - Phone:301-490-6030
Mailing Address - Fax:
Practice Address - Street 1:14811 BALTIMORE AVE
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4817
Practice Address - Country:US
Practice Address - Phone:301-490-6030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-27
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Multi-Specialty