Healthcare Provider Details

I. General information

NPI: 1245166784
Provider Name (Legal Business Name): DR. SOPHIA ROSE PEREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2026
Last Update Date: 06/22/2026
Certification Date: 06/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 NEWARK AVE STE 120
BELLEVILLE NJ
07109-4120
US

IV. Provider business mailing address

36 NEWARK AVE STE 120
BELLEVILLE NJ
07109-4120
US

V. Phone/Fax

Practice location:
  • Phone: 973-302-7551
  • Fax:
Mailing address:
  • Phone: 973-302-7551
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number27OM00211600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: