MEDICARE: DR. LIVIA IVETTE PEREZ O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	284	PR

General Provider Information

NPI Number	:	1548250053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LIVIA IVETTE PEREZ O.D.

Provider Business Mailing Address
First Line	:	13409 GANDALL CT
Second Line	:
City	:	MANASSAS
State	:	VA
Zip	:	20112-5544
Country	:	US
Telephone Number	:	703-794-1908
Fax Number	:

Provider Business Practice Location Address
First Line	:	WALTER REED ARMY MEDICAL CTR
Second Line	:	6900 GEORGIA AVE NW
City	:	WASHINGTON
State	:	DC
Zip	:	20307-0001
Country	:	US
Telephone Number	:	202-782-6688
Fax Number	:	202-782-4913

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	06/06/2008

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