1528224052 NPI number — LENSTEK LTD. T/A PEARLE VISION

Table of content: (NPI 1528224052)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528224052 NPI number — LENSTEK LTD. T/A PEARLE VISION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LENSTEK LTD. T/A PEARLE VISION
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:
6
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:
1528224052
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 278
Provider Second Line Business Mailing Address:
14455 OAKS ROAD
Provider Business Mailing Address City Name:
CHARLOTTE HALL
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20622-0278
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-884-2391
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23191 THREE NOTCH RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CALIFORNIA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20619-6024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-863-6080
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/04/2008

Additional Information

Authorized Official

Authorized Official Last Name:
GRAY
Authorized Official First Name:
EVALENA
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
240-298-0099

Provider Taxonomy Codes

  • Taxonomy code: 302F00000X , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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