MEDICARE: COURTNEY D PERRY OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	8175	TX

General Provider Information

NPI Number	:	1184065526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY D PERRY OD

Provider Business Mailing Address
First Line	:	3355 EARL CAMPBELL PKWY
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75701-8435
Country	:	US
Telephone Number	:	903-526-0444
Fax Number	:	903-595-6650

Provider Business Practice Location Address
First Line	:	1240 S PALESTINE ST
Second Line	:
City	:	ATHENS
State	:	TX
Zip	:	75751-3619
Country	:	US
Telephone Number	:	903-526-0444
Fax Number	:	903-595-6650

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/15/2013
Last Update Date	:	08/28/2025

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