Provider Demographics
NPI:1114197720
Name:DR. BRUCE A. PERRY OD
Entity Type:Organization
Organization Name:DR. BRUCE A. PERRY OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST /OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:A
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:205-932-5286
Mailing Address - Street 1:124 16TH ST NE
Mailing Address - Street 2:
Mailing Address - City:FAYETTE
Mailing Address - State:AL
Mailing Address - Zip Code:35555-1340
Mailing Address - Country:US
Mailing Address - Phone:205-932-5286
Mailing Address - Fax:
Practice Address - Street 1:124 16TH ST NE
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:AL
Practice Address - Zip Code:35555-1340
Practice Address - Country:US
Practice Address - Phone:205-932-5286
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS449TA072332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALT69020Medicare UPIN
AL0171120001Medicare NSC