Healthcare Provider Details

I. General information

NPI: 1912266404
Provider Name (Legal Business Name): ANDREW FREEMAN PERIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2012
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4104 RICHARDS RD
NORTH LITTLE ROCK AR
72117-2652
US

IV. Provider business mailing address

201 EXECUTIVE CT STE A
LITTLE ROCK AR
72205-4536
US

V. Phone/Fax

Practice location:
  • Phone: 501-224-5658
  • Fax: 501-224-8114
Mailing address:
  • Phone: 501-224-5658
  • Fax: 501-224-8114

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License Number2017-00305
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberE-9627
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: