Healthcare Provider Details

I. General information

NPI: 1356523252
Provider Name (Legal Business Name): PELLEGRINE INC/DBA PEARLE VISION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2007
Last Update Date: 12/03/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12536 OLIVE BLVD STE B
SAINT LOUIS MO
63141-6391
US

IV. Provider business mailing address

12536 OLIVE BLVD STE B
SAINT LOUIS MO
63141-6391
US

V. Phone/Fax

Practice location:
  • Phone: 314-878-1377
  • Fax: 314-878-1384
Mailing address:
  • Phone: 314-878-1377
  • Fax: 314-878-1384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. PETER JOHN PELLEGRINE
Title or Position: PRESIDENT
Credential:
Phone: 314-878-1377