Provider Demographics
NPI:1114007499
Name:PEREZ, NISET M (OD)
Entity Type:Individual
Prefix:
First Name:NISET
Middle Name:M
Last Name:PEREZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 CALLE VISTA HERMOSA
Mailing Address - Street 2:
Mailing Address - City:ISABELA
Mailing Address - State:PR
Mailing Address - Zip Code:00662-3359
Mailing Address - Country:US
Mailing Address - Phone:787-872-2121
Mailing Address - Fax:
Practice Address - Street 1:3623 AVE MILITAR ISABELA PTOFESSIONAL BLDG
Practice Address - Street 2:LOCAL 103
Practice Address - City:ISABELA
Practice Address - State:PR
Practice Address - Zip Code:00662
Practice Address - Country:US
Practice Address - Phone:787-872-2121
Practice Address - Fax:787-872-2121
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR395152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0081OtherCERTIFIED OPTOMETRIST