1841925849 NPI number — PEARLE CAPSTONE EYE ASSOCIATES, PLLC

Table of content: (NPI 1841925849)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841925849 NPI number — PEARLE CAPSTONE EYE ASSOCIATES, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEARLE CAPSTONE EYE ASSOCIATES, PLLC
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:
1841925849
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1601 NW EXPRESSWAY STE 1420
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73118-1460
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-438-0345
Provider Business Mailing Address Fax Number:
405-353-6998

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13555 FL 54 SUITE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ODESSA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33556
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-454-0670
Provider Business Practice Location Address Fax Number:
813-730-8090
Provider Enumeration Date:
07/22/2022

Additional Information

Authorized Official

Authorized Official Last Name:
DICKSON
Authorized Official First Name:
ALLISON
Authorized Official Middle Name:
Authorized Official Title or Position:
AMBR
Authorized Official Telephone Number:
616-717-1634

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)

  • Identifier: 116753900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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