Provider Demographics
NPI:1003538737
Name:PEREZ, ANTHONY (ABO)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:ABO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1888 GREEN OAKS RD STE 1980
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-1707
Mailing Address - Country:US
Mailing Address - Phone:682-266-4444
Mailing Address - Fax:817-886-3708
Practice Address - Street 1:1888 GREEN OAKS RD STE 1980
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-1707
Practice Address - Country:US
Practice Address - Phone:682-266-4444
Practice Address - Fax:817-886-3708
Is Sole Proprietor?:No
Enumeration Date:2022-09-19
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
156F00000X, 156FX1100X, 156FX1202X
TX192922156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No156F00000XEye and Vision Services ProvidersTechnician/Technologist
No156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmic
No156FX1202XEye and Vision Services ProvidersTechnician/TechnologistOptometric Technician