Provider Demographics
NPI:1497735427
Name:PEREZ, LUIS M SR (OD,FAAO)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:M
Last Name:PEREZ
Suffix:SR
Gender:M
Credentials:OD,FAAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3352 WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90023-2206
Mailing Address - Country:US
Mailing Address - Phone:323-268-1131
Mailing Address - Fax:323-268-1530
Practice Address - Street 1:3352 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90023-2206
Practice Address - Country:US
Practice Address - Phone:323-268-1131
Practice Address - Fax:323-268-1530
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-17
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12750152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0127500Medicaid
CASD0127500Medicaid