Provider Demographics
NPI:1285644666
Name:PERRY, FELTON (OD)
Entity Type:Individual
Prefix:
First Name:FELTON
Middle Name:
Last Name:PERRY
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 1:1716 UNIVERSITY BLVD
Mailing Address - Street 2:HPB G080A
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35294-0001
Mailing Address - Country:US
Mailing Address - Phone:205-934-4748
Mailing Address - Fax:205-934-6755
Practice Address - Street 1:1716 UNIVERSITY BLVD
Practice Address - Street 2:HPB G080A
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35294-0001
Practice Address - Country:US
Practice Address - Phone:205-975-2020
Practice Address - Fax:205-934-6755
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS346TA314152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000058736Medicaid
AL051058736OtherBLUE CROSS BLUE SHIELD
AL3656OtherSENIOR 1ST
AL4803280001OtherPALMETTO
AL2210082OtherUNITED HEALTH CARE
ALT69019OtherVIVA
AL051059706OtherBCBS
AL051059706OtherVIVA
MS05226256Medicaid
410042855OtherMEDICARE RAILROAD
LA1586412Medicaid
410042855OtherMEDICARE RAILROAD
AL1387502Medicare ID - Type UnspecifiedTRAVELER
T69019Medicare UPIN
AL051058736OtherBLUE CROSS BLUE SHIELD
AL051059706OtherVIVA
AL000058736Medicaid