Provider Demographics
NPI:1215161658
Name:PEAR VISION INC
Entity type:Organization
Organization Name:PEAR VISION INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:LACOGNATA
Authorized Official - Suffix:
Authorized Official - Credentials:ABO CERT OPTICIAN
Authorized Official - Phone:815-363-7101
Mailing Address - Street 1:1805 N RICHMOND RD
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60051-5415
Mailing Address - Country:US
Mailing Address - Phone:815-363-1701
Mailing Address - Fax:815-363-1765
Practice Address - Street 1:1805 N RICHMOND RD
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60051-5415
Practice Address - Country:US
Practice Address - Phone:815-363-1701
Practice Address - Fax:815-363-1765
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-13
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL=========OtherCRT-61 3945-0570