Healthcare Provider Details

I. General information

NPI: 1700941440
Provider Name (Legal Business Name): PEARLE VISION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

196 A MAIN RT.28
STONEHAM MA
02180-1619
US

IV. Provider business mailing address

196 A MAIN RT.28
STONEHAM MA
02180-1619
US

V. Phone/Fax

Practice location:
  • Phone: 781-438-0290
  • Fax: 781-279-7834
Mailing address:
  • Phone: 781-438-0290
  • Fax: 781-279-7834

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 SUPERVISOR
Credential:
Phone: 513-765-3534