Healthcare Provider Details

I. General information

NPI: 1760547756
Provider Name (Legal Business Name): PEARLE VISIONCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 12/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3401 DALE RD VINTAGE FAIRE MALL STE 303
MODESTO CA
95356-0505
US

IV. Provider business mailing address

3401 DALE RD VINTAGE FAIRE MALL STE 303
MODESTO CA
95356-0505
US

V. Phone/Fax

Practice location:
  • Phone: 209-527-6843
  • Fax:
Mailing address:
  • Phone: 209-527-6843
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MS. WENDY UHLS
Title or Position: MEDICARE ADMINISTRATOR
Credential:
Phone: 513-765-3534