Healthcare Provider Details

I. General information

NPI: 1831244557
Provider Name (Legal Business Name): PEARLE VISION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26768 DEQUINDRE RD
WARREN MI
48091-3939
US

IV. Provider business mailing address

26768 DEQUINDRE RD
WARREN MI
48091-3939
US

V. Phone/Fax

Practice location:
  • Phone: 586-751-3700
  • Fax: 586-751-5398
Mailing address:
  • Phone: 586-751-3700
  • Fax: 586-751-5398

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