Healthcare Provider Details

I. General information

NPI: 1821914409
Provider Name (Legal Business Name): AIDAN PEARL OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 EP TRUE PKWY
W DES MOINES IA
50265-7056
US

IV. Provider business mailing address

PO BOX 879
FORT WASHINGTON PA
19034-0879
US

V. Phone/Fax

Practice location:
  • Phone: 515-225-0877
  • Fax:
Mailing address:
  • Phone: 866-523-7999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number138350
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: