Provider Demographics
NPI:1598852766
Name:PERRY, JAMES R (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:PERRY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 620
Mailing Address - Street 2:
Mailing Address - City:CABOOL
Mailing Address - State:MO
Mailing Address - Zip Code:65689-0620
Mailing Address - Country:US
Mailing Address - Phone:417-962-3174
Mailing Address - Fax:417-962-5653
Practice Address - Street 1:413 OZARK ST
Practice Address - Street 2:
Practice Address - City:CABOOL
Practice Address - State:MO
Practice Address - Zip Code:65689-0620
Practice Address - Country:US
Practice Address - Phone:417-962-3174
Practice Address - Fax:417-962-5653
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2008-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOTO2767152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO312561806Medicaid
MO410008194Medicare PIN
MO312561806Medicaid
MO0490100001Medicare NSC
MO000008114Medicare PIN