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General NPI Number Information
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NPI Number | 1215057724
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Entity Type | Organization
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Legal Business Name | PEARLE VISION
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 9000 76TH ST STE A
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City | PLEASANT PRAIRIE
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State | WI
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Zip | 53158-1975
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Country | US
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Telephone | 262-697-5500
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Fax | 262-697-8589
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Provider Business Mailing Address
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Address Line | 9000 76TH ST STE A
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City | PLEASANT PRAIRIE
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State | WI
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Zip | 53158-1975
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Country | US
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Telephone | 262-697-5500
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Fax | 262-697-8589
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Authorized Official
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Title or Position | GROUP MANAGER
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Name | TATYANA LALAYAN
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Credential |
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Telephone | 847-877-0479
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number |
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License Number State | WI
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