Provider Demographics
NPI:1215675442
Name:PEARL EYE CARE CENTER, P.S.
Entity type:Organization
Organization Name:PEARL EYE CARE CENTER, P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:NOBLE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:253-472-1188
Mailing Address - Street 1:5016 BRIDGEPORT WAY W
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98467-2039
Mailing Address - Country:US
Mailing Address - Phone:253-472-1188
Mailing Address - Fax:
Practice Address - Street 1:407 BAKER BLVD
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98188-2906
Practice Address - Country:US
Practice Address - Phone:206-246-5430
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEARL EYE CARE CENTER, P.S.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty