Provider Demographics
NPI:1326344870
Name:RAPHAEL E PEREZ MD OD MBA INC
Entity Type:Organization
Organization Name:RAPHAEL E PEREZ MD OD MBA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAPHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD, OD, MBA
Authorized Official - Phone:786-853-1079
Mailing Address - Street 1:524 FERNWOOD ROAD
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33149-1842
Mailing Address - Country:US
Mailing Address - Phone:305-255-8559
Mailing Address - Fax:305-255-7880
Practice Address - Street 1:11466 S.W. QUAIL ROOST DRIVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33157
Practice Address - Country:US
Practice Address - Phone:305-255-8559
Practice Address - Fax:305-255-7880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-01
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty