Provider Demographics
NPI:1326149360
Name:PERRONE, GREGORY ALLEN (OD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:ALLEN
Last Name:PERRONE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6880 PALM AVE
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-4270
Mailing Address - Country:US
Mailing Address - Phone:707-823-7628
Mailing Address - Fax:707-823-1521
Practice Address - Street 1:6880 PALM AVE
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-4270
Practice Address - Country:US
Practice Address - Phone:707-823-7628
Practice Address - Fax:707-823-1521
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 8304T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU06191Medicare UPIN
CASD0083040Medicare PIN