Provider Demographics
NPI:1740230580
Name:PERRY, DAVID MICHAEL (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MICHAEL
Last Name:PERRY
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 1:4750 WASHINGTON SQ
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-3257
Mailing Address - Country:US
Mailing Address - Phone:651-429-3379
Mailing Address - Fax:651-429-8681
Practice Address - Street 1:4750 WASHINGTON SQ
Practice Address - Street 2:
Practice Address - City:WHITE BEAR LAKE
Practice Address - State:MN
Practice Address - Zip Code:55110-3257
Practice Address - Country:US
Practice Address - Phone:651-429-3379
Practice Address - Fax:651-429-8681
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1932152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0642002OtherPREFERRED ONE
MN2214899OtherMEDICA
MNHP21875OtherHEALTH PARTNERS
MN105475OtherUCARE
MN27024PEOtherBLUE CROSS BLUE SHIELD
MNHP21875OtherHEALTH PARTNERS