Healthcare Provider Details

I. General information

NPI: 1275679821
Provider Name (Legal Business Name): PEARLE VISION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

428 FRANDOR AVE
LANSING MI
48912-5204
US

IV. Provider business mailing address

428 FRANDOR AVE
LANSING MI
48912-5204
US

V. Phone/Fax

Practice location:
  • Phone: 517-351-1755
  • Fax: 517-351-6992
Mailing address:
  • Phone: 517-351-1755
  • Fax: 517-351-6992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: WENDY UHLS
Title or Position: MEDICARE SUPERVISOR
Credential:
Phone: 513-765-3534