Provider Demographics
NPI:1104934884
Name:GLADYS ACEVEDO DBA PEARLE VISION CENTER
Entity type:Organization
Organization Name:GLADYS ACEVEDO DBA PEARLE VISION CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLADYS
Authorized Official - Middle Name:
Authorized Official - Last Name:ACEVEDO LATORRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:787-738-7120
Mailing Address - Street 1:PO BOX 372000
Mailing Address - Street 2:JESUS T PINERO 4005 PEREZ HERMANOS PLAZA
Mailing Address - City:CAYEY
Mailing Address - State:PR
Mailing Address - Zip Code:00736
Mailing Address - Country:US
Mailing Address - Phone:787-738-7120
Mailing Address - Fax:787-738-7140
Practice Address - Street 1:JESUS T PINERO 4005
Practice Address - Street 2:PEREZ HERMANOS PLAZA
Practice Address - City:CAYEY
Practice Address - State:PR
Practice Address - Zip Code:00736
Practice Address - Country:US
Practice Address - Phone:787-738-7120
Practice Address - Fax:787-738-7140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty