Healthcare Provider Details

I. General information

NPI: 1811003874
Provider Name (Legal Business Name): DANIEL RAY PERRINE JR. O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 12/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10950 NEW HALLS FERRY RD
SAINT LOUIS MO
63136-4435
US

IV. Provider business mailing address

8656 OLD TOWNE DR
SAINT LOUIS MO
63132-3908
US

V. Phone/Fax

Practice location:
  • Phone: 314-388-9999
  • Fax: 314-388-9990
Mailing address:
  • Phone: 614-284-1798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2008028014
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: