MEDICARE: PEARLE VISION 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	152W00000X	Optometrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457491508
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PEARLE VISION INC

Provider Business Mailing Address
First Line	:	4359 WESTLAND MALL
Second Line	:	SP. C26
City	:	COLUMBUS
State	:	OH
Zip	:	43228-1628
Country	:	US
Telephone Number	:	614-351-5252
Fax Number	:	614-351-5254

Provider Business Practice Location Address
First Line	:	4359 WESTLAND MALL
Second Line	:	SP. C26
City	:	COLUMBUS
State	:	OH
Zip	:	43228-1628
Country	:	US
Telephone Number	:	614-351-5252
Fax Number	:	614-351-5254

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

Provider Enumeration Date	:	02/07/2007
Last Update Date	:	08/22/2020

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Directions to “PEARLE VISION INC ” Practice Location

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