Provider Demographics
NPI:1124279781
Name:PEARLE VISION
Entity type:Organization
Organization Name:PEARLE VISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROSSARIO
Authorized Official - Middle Name:
Authorized Official - Last Name:DITTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:973-882-5554
Mailing Address - Street 1:766 BLOOMFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-6710
Mailing Address - Country:US
Mailing Address - Phone:973-882-5554
Mailing Address - Fax:
Practice Address - Street 1:766 BLOOMFIELD AVE
Practice Address - Street 2:
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-6710
Practice Address - Country:US
Practice Address - Phone:973-882-5554
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-01
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier