Provider Demographics
NPI:1164406740
Name:PERKINS, ROBERT RAY (OD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:RAY
Last Name:PERKINS
Suffix:
Gender:M
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:PO BOX 883
Mailing Address - Street 2:
Mailing Address - City:THE DALLES
Mailing Address - State:OR
Mailing Address - Zip Code:97058-0883
Mailing Address - Country:US
Mailing Address - Phone:541-296-2911
Mailing Address - Fax:541-296-2224
Practice Address - Street 1:415 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:THE DALLES
Practice Address - State:OR
Practice Address - Zip Code:97058-2215
Practice Address - Country:US
Practice Address - Phone:541-296-2911
Practice Address - Fax:541-296-2224
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1246T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR236075Medicaid
OR236075Medicaid
ORR00WCJSGCMedicare PIN
T76656Medicare UPIN