Healthcare Provider Details

I. General information

NPI: 1659376374
Provider Name (Legal Business Name): PERLA VENETTE BERMUDEZ O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 E HOLLAND AVE STE 6
ALPINE TX
79830-5007
US

IV. Provider business mailing address

PO BOX 1855
ALPINE TX
79831-1855
US

V. Phone/Fax

Practice location:
  • Phone: 432-837-3699
  • Fax: 432-837-3696
Mailing address:
  • Phone: 432-837-3699
  • Fax: 432-837-3696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number6335TG
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: