Provider Demographics
NPI:1639131899
Name:PERALA, DANIEL R (OD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:R
Last Name:PERALA
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 1:2528 DELL RANGE BLVD
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-5273
Mailing Address - Country:US
Mailing Address - Phone:307-634-2503
Mailing Address - Fax:307-634-4878
Practice Address - Street 1:2528 DELL RANGE BLVD
Practice Address - Street 2:
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-5273
Practice Address - Country:US
Practice Address - Phone:307-634-2503
Practice Address - Fax:307-634-4878
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY220T152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYU34008Medicare UPIN
WY4080380001Medicare ID - Type Unspecified