Provider Demographics
NPI:1235731373
Name:PEREZ, EDWARD ISAAC (OD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ISAAC
Last Name:PEREZ
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 1:4205 SUNDANCE CIR
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78599-3000
Mailing Address - Country:US
Mailing Address - Phone:956-560-3817
Mailing Address - Fax:
Practice Address - Street 1:4205 SUNDANCE CIR
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78599-3000
Practice Address - Country:US
Practice Address - Phone:956-560-3817
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-13
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX390200000X
TX10140T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program