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General NPI Number Information
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NPI Number | 1760607816
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Entity Type | Organization
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Legal Business Name | RICHARD A. PERROTT OD PA
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Dates
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Enumeration Date | 04/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 15 NE 5TH ST
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City | GRAND RAPIDS
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State | MN
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Zip | 55744-2601
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Country | US
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Telephone | 218-327-1148
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Fax | 218-327-0386
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Provider Business Mailing Address
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Address Line | 15 NE 5TH ST
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City | GRAND RAPIDS
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State | MN
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Zip | 55744-2601
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Country | US
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Telephone | 218-327-1148
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Fax | 218-327-0386
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Authorized Official
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Title or Position | OWNER
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Name | DR. RICHARD A PERROTT
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Credential | O.D.
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Telephone | 218-327-1148
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1638
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License Number State | MN
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