Healthcare Provider Details

I. General information

NPI: 1659582492
Provider Name (Legal Business Name): PEARLE VISION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

485 ARSENAL ST
WATERTOWN MA
02472-5091
US

IV. Provider business mailing address

57 THORNDIKE ST
BROOKLINE MA
02446-2405
US

V. Phone/Fax

Practice location:
  • Phone: 617-923-2022
  • Fax:
Mailing address:
  • Phone: 617-272-6298
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: MS. LUBOV NASCIMENTO
Title or Position: MANAGER
Credential: RDO #5548
Phone: 617-923-2022