Provider Demographics
NPI:1467588400
Name:PEREZ, JEFFREY J (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:J
Last Name:PEREZ
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 1:12296 ASHLEY DR
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39503
Mailing Address - Country:US
Mailing Address - Phone:228-831-0515
Mailing Address - Fax:228-831-0698
Practice Address - Street 1:12296 ASHLEY DR
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-0000
Practice Address - Country:US
Practice Address - Phone:228-831-0515
Practice Address - Fax:228-831-0698
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2009-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS485152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00087904Medicaid
MS251005OtherNVA
MS7019OtherDAVISVISION
MS0414350001OtherPALMETTO GOVERNMENT BENEFITS ADMINISTRATOR
MS7020OtherDAVISVISION
MS111841OtherEYEMED
MS111841OtherEYEMED