Provider Demographics
NPI:1760607816
Name:RICHARD A. PERROTT OD PA
Entity Type:Organization
Organization Name:RICHARD A. PERROTT OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:PERROTT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:218-327-1148
Mailing Address - Street 1:15 NE 5TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-2601
Mailing Address - Country:US
Mailing Address - Phone:218-327-1148
Mailing Address - Fax:218-327-0386
Practice Address - Street 1:15 NE 5TH ST
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-2601
Practice Address - Country:US
Practice Address - Phone:218-327-1148
Practice Address - Fax:218-327-0386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1638152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN70514PEOtherBLUE CROSS GROUP
MN98383OtherPREFERRED ONE GROUP
MN22-00208OtherMEDICA
MN70514PEOtherBLUE CROSS GROUP
MN98383OtherPREFERRED ONE GROUP