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General NPI Number Information
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NPI Number | 1366698326
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Entity Type | Organization
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Legal Business Name | LENSTEK LTD. T/A PEARLE VISION
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Dates
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Enumeration Date | 08/11/2008
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 3005 LEONARDTOWN RD
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City | WALDORF
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State | MD
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Zip | 20601-3136
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Country | US
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Telephone | 301-645-6550
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 278 14455 OAKS ROAD
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City | CHARLOTTE HALL
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State | MD
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Zip | 20622-0278
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Country | US
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Telephone | 301-884-2391
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. EVALENA W. GRAY
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Credential | OPTICIAN
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Telephone | 240-298-0099
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State | MD
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