Provider Demographics
NPI:1558313379
Name:PERRY, RALPH BARNES SR (OD)
Entity Type:Individual
Prefix:DR
First Name:RALPH
Middle Name:BARNES
Last Name:PERRY
Suffix:SR
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 SW
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:2013-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC769152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
C0600OtherMEDCOST
P00129884OtherRAILROAD MEDICARE
0312480001OtherPALMETTO GBA
NC09707OtherBCBS
NC97184003OtherUHC
NC8909707Medicaid
NC09707OtherBCBS
NC0312480001Medicare NSC
T64658Medicare UPIN