MEDICARE: DR. FREDY 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	06315 T	CA

Other Identifiers

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

General Provider Information

NPI Number	:	1962424135
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. FREDY PEREZ O.D.

Provider Business Mailing Address
First Line	:	370 MAVIS DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90065-5014
Country	:	US
Telephone Number	:	323-227-5490
Fax Number	:

Provider Business Practice Location Address
First Line	:	1509 SUNSET BL.
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026
Country	:	US
Telephone Number	:	213-250-5768
Fax Number	:	213-250-5773

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

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	05/12/2008

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