Provider Demographics
NPI:1548212376
Name:PERRY, RALPH BARNES JR (OD)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:BARNES
Last Name:PERRY
Suffix:JR
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 1:2402 MONTGOMERY DR
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-4421
Mailing Address - Country:US
Mailing Address - Phone:252-243-2020
Mailing Address - Fax:252-291-2020
Practice Address - Street 1:2402 MONTGOMERY DR
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-4421
Practice Address - Country:US
Practice Address - Phone:252-243-2020
Practice Address - Fax:252-291-2020
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2013-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1298152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC001933915003OtherUHC
NC0905VOtherBCBS
NC890905VMedicaid
C0601OtherMEDCOST
P00129884OtherRAILROAD MEDICARE
U08374Medicare UPIN
NC890905VMedicaid
NC0312480001Medicare NSC