Healthcare Provider Details

I. General information

NPI: 1548250053
Provider Name (Legal Business Name): LIVIA IVETTE PEREZ O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2005
Last Update Date: 06/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WALTER REED ARMY MEDICAL CTR 6900 GEORGIA AVE NW
WASHINGTON DC
20307-0001
US

IV. Provider business mailing address

13409 GANDALL CT
MANASSAS VA
20112-5544
US

V. Phone/Fax

Practice location:
  • Phone: 202-782-6688
  • Fax: 202-782-4913
Mailing address:
  • Phone: 703-794-1908
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number284
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: