Provider Demographics
NPI:1467012740
Name:LUIS G. PEREZ-RIVERA OD OPTOMETRIC CORPORATION
Entity Type:Organization
Organization Name:LUIS G. PEREZ-RIVERA OD OPTOMETRIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUIS
Authorized Official - Middle Name:G
Authorized Official - Last Name:PEREZ-RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:858-673-1084
Mailing Address - Street 1:11134 RANCHO CARMEL DR STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-4671
Mailing Address - Country:US
Mailing Address - Phone:858-673-1084
Mailing Address - Fax:858-673-1867
Practice Address - Street 1:11134 RANCHO CARMEL DR STE 102
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-4671
Practice Address - Country:US
Practice Address - Phone:858-673-1084
Practice Address - Fax:858-673-1867
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty