MEDICARE: PEARLE VISION INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1124357355
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEARLE VISION INC

Provider Business Mailing Address
First Line	:	4000 LUXOTTICA PL
Second Line	:	ATTN MEDICARE DEPT
City	:	MASON
State	:	OH
Zip	:	45040-8114
Country	:	US
Telephone Number	:	812-332-9014
Fax Number	:

Provider Business Practice Location Address
First Line	:	3024 E 3RD ST
Second Line	:	COLLEGE MALL STE #L05C
City	:	BLOOMINGTON
State	:	IN
Zip	:	47401-5425
Country	:	US
Telephone Number	:	812-332-9014
Fax Number	:

Authorized Official
Title or Position	:	MEDICARE ADMINISTRATOR
Name	:	WENDY UHLS
Credential	:
Telephone Number	:	513-765-3534

Provider Enumeration Date	:	12/17/2009
Last Update Date	:	12/17/2009

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Directions to “PEARLE VISION INC ” Practice Location

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