Provider Demographics
NPI:1548388358
Name:PERRY, MICHELLE LYNAY (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:LYNAY
Last Name:PERRY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2904 YORKSHIRE CT
Mailing Address - Street 2:
Mailing Address - City:SOUTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76092-5626
Mailing Address - Country:US
Mailing Address - Phone:817-431-5026
Mailing Address - Fax:
Practice Address - Street 1:2904 YORKSHIRE CT
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-5626
Practice Address - Country:US
Practice Address - Phone:817-431-5026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX06499 T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX06499 TOtherTEXAS OPTOMETRY LICENSE