Healthcare Provider Details

I. General information

NPI: 1235112582
Provider Name (Legal Business Name): PEARLE VISION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 CALLE GARRIDO MORALES W
FAJARDO PR
00738-4632
US

IV. Provider business mailing address

K15 CALLE I
CAROLINA PR
00987-7138
US

V. Phone/Fax

Practice location:
  • Phone: 787-863-3580
  • Fax: 787-860-1333
Mailing address:
  • Phone: 787-396-6623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number608
License Number StatePR

VIII. Authorized Official

Name: DR. MIRLA KYRENIA ERAUSQUIN
Title or Position: OPTOMETRY DOCTOR
Credential: O.D.
Phone: 787-396-6623