Healthcare Provider Details

I. General information

NPI: 1073299723
Provider Name (Legal Business Name): AMBER PERREN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2023
Last Update Date: 11/10/2024
Certification Date: 11/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6118 SE FEDERAL HWY
STUART FL
34997-8105
US

IV. Provider business mailing address

4095 SE WESTFIELD ST
STUART FL
34997-6810
US

V. Phone/Fax

Practice location:
  • Phone: 561-339-5551
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number6270
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: