Provider Demographics
NPI:1598735110
Name:PERDUE, DANIEL C (OD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:C
Last Name:PERDUE
Suffix:
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 1:4403 W COURT ST
Mailing Address - Street 2:SUITE J
Mailing Address - City:PASCO
Mailing Address - State:WA
Mailing Address - Zip Code:99301-2879
Mailing Address - Country:US
Mailing Address - Phone:509-547-9695
Mailing Address - Fax:509-547-5017
Practice Address - Street 1:4403 W COURT ST
Practice Address - Street 2:SUITE J
Practice Address - City:PASCO
Practice Address - State:WA
Practice Address - Zip Code:99301-2879
Practice Address - Country:US
Practice Address - Phone:509-547-9695
Practice Address - Fax:509-547-5017
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2007-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3345152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2020691Medicaid
WAAB01111Medicare ID - Type Unspecified
WA2020691Medicaid