MEDICARE: PEARLE VISIONCARE, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1174688188
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEARLE VISIONCARE, INC

Provider Business Mailing Address
First Line	:	1620 SARATOGA AVE
Second Line	:	WESTGATE S/C #P-301
City	:	SAN JOSE
State	:	CA
Zip	:	95129-5113
Country	:	US
Telephone Number	:	408-374-1001
Fax Number	:

Provider Business Practice Location Address
First Line	:	1620 SARATOGA AVE
Second Line	:	WESTGATE S/C #P-301
City	:	SAN JOSE
State	:	CA
Zip	:	95129-5113
Country	:	US
Telephone Number	:	408-374-1001
Fax Number	:

Authorized Official
Title or Position	:	MEDICARE SUPERVISOR
Name	:	MS. WENDY UHLS
Credential	:
Telephone Number	:	513-765-3534

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	04/11/2008

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