MEDICARE: PEARLE VISION EXPRESS

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	156FX1800X	Optician	17822	CA

General Provider Information

NPI Number	:	1306051701
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEARLE VISION EXPRESS

Provider Business Mailing Address
First Line	:	7111 MARVIN D LOVE FWY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75237-3106
Country	:	US
Telephone Number	:	972-298-1454
Fax Number	:

Provider Business Practice Location Address
First Line	:	7111 MARVIN D LOVE FWY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75237-3106
Country	:	US
Telephone Number	:	972-298-1454
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	ALEX TREPETIN
Credential	:
Telephone Number	:	972-298-1454

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	08/22/2020

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Directions to “PEARLE VISION EXPRESS ” Practice Location

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