1386867257 NPI number — PEARSON EYECARE GROUP, LLC

Table of content: (NPI 1386867257)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386867257 NPI number — PEARSON EYECARE GROUP, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEARSON EYECARE GROUP, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386867257
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6555 E SOUTHERN AVE
Provider Second Line Business Mailing Address:
#1508
Provider Business Mailing Address City Name:
MESA
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85206-3724
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-890-0618
Provider Business Mailing Address Fax Number:
480-462-0121

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1649 S STAPLEY DR
Provider Second Line Business Practice Location Address:
#108
Provider Business Practice Location Address City Name:
MESA
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85204-6649
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-345-7520
Provider Business Practice Location Address Fax Number:
480-844-8699
Provider Enumeration Date:
04/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PEARSON
Authorized Official First Name:
KERRY
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
480-345-7520

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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