Healthcare Provider Details

I. General information

NPI: 1528069754
Provider Name (Legal Business Name): STACI PALMER PEREZ OD.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3929 TINSLEY DR SUITE 101
HIGH POINT NC
27265-1530
US

IV. Provider business mailing address

3929 TINSLEY DR SUITE 101
HIGH POINT NC
27265-1530
US

V. Phone/Fax

Practice location:
  • Phone: 336-841-2028
  • Fax: 336-841-2029
Mailing address:
  • Phone: 336-841-2028
  • Fax: 336-841-2029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1738
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: