Healthcare Provider Details

I. General information

NPI: 1043627466
Provider Name (Legal Business Name): GRACE VISION, INC DBA PEARLE VISION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2014
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 WHITE BEAR AVE N SUITE 1050
SAINT PAUL MN
55109-1215
US

IV. Provider business mailing address

3001 WHITE BEAR AVE N STE 1050
SAINT PAUL MN
55109-1283
US

V. Phone/Fax

Practice location:
  • Phone: 651-770-3923
  • Fax:
Mailing address:
  • Phone: 651-770-3923
  • Fax: 651-770-5316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License Number
License Number State

VIII. Authorized Official

Name: JEANNY M LIU-WU
Title or Position: OWNER
Credential:
Phone: 651-770-3923