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General NPI Number Information
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NPI Number | 1205981636
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Entity Type | Organization
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Legal Business Name | PEARLE VISION INC
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 21500 NORTHWESTERN HWY SP D17C
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City | SOUTHFIELD
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State | MI
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Zip | 48075-5018
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Country | US
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Telephone | 248-559-3737
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Fax | 248-559-8211
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Provider Business Mailing Address
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Address Line | 21500 NORTHWESTERN HWY SP D17C
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City | SOUTHFIELD
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State | MI
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Zip | 48075-5018
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Country | US
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Telephone | 248-559-3737
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Fax | 248-559-8211
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Authorized Official
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Title or Position | MEDICARE SUPERVISOR
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Name | WENDY UHLS
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Credential |
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Telephone | 513-765-3534
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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