Provider Demographics
NPI:1124164769
Name:PEARLE VISION INC
Entity type:Organization
Organization Name:PEARLE VISION INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICARE SUPERVISOR
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:
Authorized Official - Last Name:UHLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-765-3534
Mailing Address - Street 1:4520 W MAIN ST
Mailing Address - Street 2:WESTWOOD PLAZA
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49006-2605
Mailing Address - Country:US
Mailing Address - Phone:269-345-9833
Mailing Address - Fax:
Practice Address - Street 1:4520 W MAIN ST
Practice Address - Street 2:WESTWOOD PLAZA
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49006-2605
Practice Address - Country:US
Practice Address - Phone:269-345-9833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0132600643Medicare NSC