Provider Demographics
NPI:1326127705
Name:PERKINS, ROBERT LARRY (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LARRY
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 1:1224 HUNTSVILLE HWY
Mailing Address - Street 2:DR R LARRY PERKINS
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37334
Mailing Address - Country:US
Mailing Address - Phone:931-438-3400
Mailing Address - Fax:
Practice Address - Street 1:1224 HUNTSVILLE HWY
Practice Address - Street 2:DR R LARRY PERKINS
Practice Address - City:FAYETTEVILLE
Practice Address - State:TN
Practice Address - Zip Code:37334
Practice Address - Country:US
Practice Address - Phone:931-438-3400
Practice Address - Fax:931-438-0650
Is Sole Proprietor?:No
Enumeration Date:2006-11-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN619152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
04026OtherSPECTRA
47763OtherDAVIS
TN3000206OtherBCBS
04026OtherSPECTRA
T61163Medicare UPIN