Provider Demographics
NPI:1376505396
Name:PERYEA, VERNON ALLEN (OD)
Entity Type:Individual
Prefix:DR
First Name:VERNON
Middle Name:ALLEN
Last Name:PERYEA
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 1:88 PUTNAM RD
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567-7446
Mailing Address - Country:US
Mailing Address - Phone:845-661-7498
Mailing Address - Fax:914-737-0437
Practice Address - Street 1:1865 MAIN ST
Practice Address - Street 2:OIC OPTICAL
Practice Address - City:PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10566-2505
Practice Address - Country:US
Practice Address - Phone:914-737-0437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV0063211152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYC303D1Medicare ID - Type Unspecified
U98287Medicare UPIN