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	:	1982744033
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEARLE VISION INC

Provider Business Mailing Address
First Line	:	124 SAINT CLAIR SQ
Second Line	:
City	:	FAIRVIEW HEIGHTS
State	:	IL
Zip	:	62208-2135
Country	:	US
Telephone Number	:	618-624-2266
Fax Number	:

Provider Business Practice Location Address
First Line	:	124 SAINT CLAIR SQ
Second Line	:
City	:	FAIRVIEW HEIGHTS
State	:	IL
Zip	:	62208-2135
Country	:	US
Telephone Number	:	618-624-2266
Fax Number	:

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

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	04/25/2008

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Directions to “PEARLE VISION INC ” Practice Location

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