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General NPI Number Information
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NPI Number | 1649644485
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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 | 11/17/2015
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Last Update Date | 11/17/2015
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Provider Practice Location Address
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Address Line | 1384 E BELT LINE RD
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City | RICHARDSON
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State | TX
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Zip | 75081-3709
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Country | US
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Telephone | 972-428-8612
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Fax |
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Provider Business Mailing Address
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Address Line | 5408 CREEK ARBOR CT
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City | DALLAS
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State | TX
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Zip | 75287-7504
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Country | US
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Telephone | 972-428-8612
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Fax |
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Authorized Official
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Title or Position | PROPRIETOR
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Name | DR. JAMES DAVID BENNING
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Credential | O.D.
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Telephone | 972-428-8612
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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 | 3265T
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License Number State | TX
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