Healthcare Provider Details

I. General information

NPI: 1255477808
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: 04/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5020 W SAGINAW HWY
LANSING MI
48917-2625
US

IV. Provider business mailing address

5020 W SAGINAW HWY
LANSING MI
48917-2625
US

V. Phone/Fax

Practice location:
  • Phone: 517-321-7644
  • Fax:
Mailing address:
  • Phone: 517-321-7644
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

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