Provider Demographics
NPI:1659376374
Name:BERMUDEZ, PERLA VENETTE (OD)
Entity Type:Individual
Prefix:DR
First Name:PERLA
Middle Name:VENETTE
Last Name:BERMUDEZ
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:PO BOX 1855
Mailing Address - Street 2:
Mailing Address - City:ALPINE
Mailing Address - State:TX
Mailing Address - Zip Code:79831-1855
Mailing Address - Country:US
Mailing Address - Phone:432-837-3699
Mailing Address - Fax:432-837-3696
Practice Address - Street 1:710 E HOLLAND AVE STE 5
Practice Address - Street 2:
Practice Address - City:ALPINE
Practice Address - State:TX
Practice Address - Zip Code:79830-5007
Practice Address - Country:US
Practice Address - Phone:432-837-3699
Practice Address - Fax:432-837-3696
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6335TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7744535OtherAETNA
0036FBOtherBCBS
TX36FBOtherBCBS
TX205532901Medicaid
TX7744535OtherAETNA
TX611228Medicare PIN