Provider Demographics
NPI:1235206400
Name:PERLOW, ANNMARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:ANNMARIE
Middle Name:
Last Name:PERLOW
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:ANN
Other - Middle Name:M
Other - Last Name:PERLOW
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:1150 RESERVOIR AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-6068
Mailing Address - Country:US
Mailing Address - Phone:401-943-8151
Mailing Address - Fax:401-943-1324
Practice Address - Street 1:1150 RESERVOIR AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-6068
Practice Address - Country:US
Practice Address - Phone:401-943-8151
Practice Address - Fax:401-943-1324
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIODTG 00436152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI1295856540OtherORGANIZATION/GROUP NPI
RIGC00269Medicaid
RI1295856540OtherORGANIZATION/GROUP NPI
RIGC00269Medicaid
RI0399810001Medicare NSC
RI007007045Medicare PIN