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NPI Code Detail

MEDICARE: LUIS PEREZ O.D.

MEDICARE:   LUIS  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
1152W00000XOptometrist6799TTX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1760596456
Entity Type Code : Individual
Provider Name (Legal Business Name) : LUIS PEREZ O.D.
Provider Business Mailing Address
First Line : 3323 S LOOP 256
Second Line :
City : PALESTINE
State : TX
Zip : 75801-6977
Country : US
Telephone Number : 903-723-1010
Fax Number : 903-723-0314
Provider Business Practice Location Address
First Line : 1200 W MAIN ST
Second Line : SUITE A
City : GUN BARREL CITY
State : TX
Zip : 75156-5320
Country : US
Telephone Number : 903-880-9900
Fax Number : 903-880-9902
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2006
Last Update Date : 07/08/2007

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Directions to “ LUIS PEREZ O.D.” Practice Location

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