=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164558516
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PEARLE VISION CENTER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/27/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 20 COMMERCE WAY
-----------------------------------------------------
City | SEEKONK
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02771
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-336-7040
-----------------------------------------------------
Fax | 508-336-7044
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20 COMMERCE WAY
-----------------------------------------------------
City | SEEKONK
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02771
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-336-7040
-----------------------------------------------------
Fax | 508-336-7044
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OPTICIAN OWNER
-----------------------------------------------------
Name | MR. PATRICK G PENDER
-----------------------------------------------------
Credential | RDO
-----------------------------------------------------
Telephone | 508-336-7040
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332H00000X
-----------------------------------------------------
Taxonomy Name | Eyewear Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------