Provider Demographics
NPI:1548306004
Name:PEARLE VISION INC
Entity type:Organization
Organization Name:PEARLE VISION INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICARE ADMINISTRATOR
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 1:95 N MOORLAND RD
Mailing Address - Street 2:BROOKFIELD SQUARE MALL UNIT #A1
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-6020
Mailing Address - Country:US
Mailing Address - Phone:262-786-0300
Mailing Address - Fax:
Practice Address - Street 1:95 N MOORLAND RD
Practice Address - Street 2:BROOKFIELD SQUARE MALL UNIT #A1
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-6020
Practice Address - Country:US
Practice Address - Phone:262-786-0300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0132600649Medicare NSC