MEDICARE: PERALA ENTERPRISES, LLC

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	332H00000X	Eyewear Supplier

General Provider Information

NPI Number	:	1992957252
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERALA ENTERPRISES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 21676
Second Line	:
City	:	CHEYENNE
State	:	WY
Zip	:	82003-7031
Country	:	US
Telephone Number	:	307-632-1369
Fax Number	:	307-632-2161

Provider Business Practice Location Address
First Line	:	6207 MISSILE DR
Second Line	:	BUILDING 722
City	:	FT WARREN AFB
State	:	WY
Zip	:	82005-2407
Country	:	US
Telephone Number	:	307-632-1369
Fax Number	:	307-632-2161

Authorized Official
Title or Position	:	MANAGER
Name	:	MRS. PATRICIA S GREEN
Credential	:	ABOC, FNAO
Telephone Number	:	307-632-1369

Provider Enumeration Date	:	10/17/2008
Last Update Date	:	10/17/2008

Similar Medicare Providers

1871796060 — IMPRIMIS HEALTHGROUP LLC
Practice Location Address:

1210 NE 4 STREET
FT LAUDERDALE, FL
33301-2407

Practice Phone: 954-892-1926
Practice Fax:

1396119681 — AMC BAMC-FSH
Practice Location Address:

2407 N NEW BRAUNFELS , BLDG 147
FT SAM HOUSTON, TX
78234

Practice Phone: 210-916-0475
Practice Fax:

1295728756 — DR. TEDDY LYNN ELLIS D.D.S.
Practice Location Address:

6900 ALDEN DR
FT WARREN AFB, WY
82005-3906

Practice Phone: 402-651-1386
Practice Fax:

1447359278 — DR. BRIAN PATRICK HAYES MD, MPH
Practice Location Address:

6900 ALDEN DR
FT WARREN AFB, WY
82005-3906

Practice Phone: 307-773-2277
Practice Fax: 307-773-4665

1083709588 — DR. JAMES LOUIS KRETZSCHMAR DDS
Practice Location Address:

6900 ALDEN DR
FT WARREN AFB, WY
82005-3906

Practice Phone: 307-773-1846
Practice Fax:

1568520468 — MR. MATT JAMES COWAN RPH
Practice Location Address:

6900 ALDEN DR
FT WARREN AFB, WY
82005-3906

Practice Phone: 307-773-3478
Practice Fax: 307-773-4589

Directions to “PERALA ENTERPRISES, LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.