Healthcare Provider Details

I. General information

NPI: 1821571043
Provider Name (Legal Business Name): STEVEN THOMAS PERRY OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2018
Last Update Date: 11/02/2026
Certification Date: 11/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4028 DALE RD STE 102
MODESTO CA
95356-9561
US

IV. Provider business mailing address

4028 DALE RD STE 102
MODESTO CA
95356-9561
US

V. Phone/Fax

Practice location:
  • Phone: 209-527-2020
  • Fax: 209-527-5079
Mailing address:
  • Phone: 209-527-2020
  • Fax: 209-527-5079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number34101TLG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: