Provider Demographics
NPI:1710279484
Name:VERNON PERYEA, LLC
Entity Type:Organization
Organization Name:VERNON PERYEA, LLC
Other - Org Name:OIC OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:PERYEA
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:914-737-0437
Mailing Address - Street 1:PO BOX 426
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL
Mailing Address - State:NY
Mailing Address - Zip Code:12533-0426
Mailing Address - Country:US
Mailing Address - Phone:845-221-5310
Mailing Address - Fax:845-226-1464
Practice Address - Street 1:1123 ROUTE 82
Practice Address - Street 2:
Practice Address - City:HOPEWELL
Practice Address - State:NY
Practice Address - Zip Code:12533-6206
Practice Address - Country:US
Practice Address - Phone:845-221-5310
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-12
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYIUV006321-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1376505396OtherCURRENT NPI
NYTUV0063211OtherLICENSE
NY1801188776Medicare NSC
NYTUV0063211OtherLICENSE