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NPI Code Detail

MEDICARE: PEARLE VISION INC

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
1332H00000XEyewear Supplier

General Provider Information

NPI Number : 1750613188
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 : 952-926-6149
Fax Number :
Provider Business Practice Location Address
First Line : 3333 HAZELTON RD
Second Line : YORKTOWN MALL
City : EDINA
State : MN
Zip : 55435-4204
Country : US
Telephone Number : 952-926-6149
Fax Number :
Authorized Official
Title or Position : MEDICARE ADMINISTRATOR
Name : WENDY UHLS
Credential :
Telephone Number : 513-765-3534
Provider Enumeration Date : 02/10/2010
Last Update Date : 02/10/2010

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