Provider Demographics
NPI:1598456675
Name:PERRY, ANASTASIA (OD)
Entity Type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:
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 1:2405 MARYLAND RD UNIT 413
Mailing Address - Street 2:
Mailing Address - City:WILLOW GROVE
Mailing Address - State:PA
Mailing Address - Zip Code:19090-1774
Mailing Address - Country:US
Mailing Address - Phone:860-866-6362
Mailing Address - Fax:
Practice Address - Street 1:140 WELSH ROAD SUITE 220
Practice Address - Street 2:
Practice Address - City:NORTH WALES
Practice Address - State:PA
Practice Address - Zip Code:19454-2033
Practice Address - Country:US
Practice Address - Phone:215-542-1522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG004014152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist