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General NPI Number Information
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NPI Number | 1376693358
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Entity Type | Organization
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Legal Business Name | PEARLE VISION CENTER OF PUERTO RICO, INC
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Dates
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Enumeration Date | 01/11/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1122 AVE PONCE DE LEON RIO PIEDRAS #1122
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City | SAN JUAN
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State | PR
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Zip | 00925-2908
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Country | US
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Telephone | 787-765-0063
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Fax | 787-765-7035
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Provider Business Mailing Address
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Address Line | 1122 AVE PONCE DE LEON RIO PIEDRAS #1122
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City | SAN JUAN
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State | PR
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Zip | 00925-2908
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Country | US
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Telephone | 787-765-0063
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Fax | 787-765-7035
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Authorized Official
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Title or Position | MEDICARE SUPERVISOR
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Name | MS. 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 | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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