Healthcare Provider Details

I. General information

NPI: 1497463350
Provider Name (Legal Business Name): PEARLE CAPSTONE EYE ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2022
Last Update Date: 11/09/2022
Certification Date: 11/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25434 SIERRA CENTER BLVD
LUTZ FL
33559-7322
US

IV. Provider business mailing address

1601 NW EXPRESSWAY STE 1420
OKLAHOMA CITY OK
73118-1460
US

V. Phone/Fax

Practice location:
  • Phone: 813-452-4442
  • Fax: 813-352-3134
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: ALLISON PAGE DICKSON
Title or Position: CMO
Credential: OD
Phone: 616-459-0641