Provider Demographics
NPI:1154842961
Name:PERLMAN-HENSEN, ALYSSA (OD)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:PERLMAN-HENSEN
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 1:1900 MASON AVE SUITE 100
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117
Mailing Address - Country:US
Mailing Address - Phone:386-274-5525
Mailing Address - Fax:803-296-7330
Practice Address - Street 1:1900 MASON AVE SUITE 100
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117
Practice Address - Country:US
Practice Address - Phone:386-274-5525
Practice Address - Fax:803-434-1581
Is Sole Proprietor?:No
Enumeration Date:2017-06-30
Last Update Date:2021-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2034152W00000X
MA5214152W00000X, 152WC0802X
FLCPC5617152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL110772100Medicaid
SCD20341Medicaid