Provider Demographics
NPI:1437831674
Name:PERRY, TAKEIYA (LICENSED OPTICIAN)
Entity Type:Individual
Prefix:
First Name:TAKEIYA
Middle Name:
Last Name:PERRY
Suffix:
Gender:F
Credentials:LICENSED OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2104
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-0015
Mailing Address - Country:US
Mailing Address - Phone:857-256-0225
Mailing Address - Fax:
Practice Address - Street 1:42 SIENNA LANE
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760
Practice Address - Country:US
Practice Address - Phone:857-256-0225
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA240196156FC0800X, 156FC0801X
MADOP100039156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No156FC0800XEye and Vision Services ProvidersTechnician/TechnologistContact Lens
No156FC0801XEye and Vision Services ProvidersTechnician/TechnologistContact Lens Fitter