Provider Demographics
NPI:1295890275
Name:PEARLE VISIONCARE, INC
Entity type:Organization
Organization Name:PEARLE VISIONCARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICARE SUPERVISOR
Authorized Official - Prefix:MS
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 1:4200 KLOSE WAY # B
Mailing Address - Street 2:HILLTOP PLAZA
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94806-5713
Mailing Address - Country:US
Mailing Address - Phone:510-223-8200
Mailing Address - Fax:510-223-8293
Practice Address - Street 1:4200 KLOSE WAY # B
Practice Address - Street 2:HILLTOP PLAZA
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94806-5713
Practice Address - Country:US
Practice Address - Phone:510-223-8200
Practice Address - Fax:510-223-8293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0132600452Medicare ID - Type Unspecified