Provider Demographics
NPI:1760640973
Name:PERRI, MARK
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:PERRI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:827 CENTRAL AVE
Mailing Address - Street 2:SUITE 3
Mailing Address - City:DOVER
Mailing Address - State:NH
Mailing Address - Zip Code:03820-2577
Mailing Address - Country:US
Mailing Address - Phone:603-749-9122
Mailing Address - Fax:603-749-2803
Practice Address - Street 1:827 CENTRAL AVE
Practice Address - Street 2:SUITE 3
Practice Address - City:DOVER
Practice Address - State:NH
Practice Address - Zip Code:03820-2577
Practice Address - Country:US
Practice Address - Phone:603-749-9122
Practice Address - Fax:603-749-2803
Is Sole Proprietor?:No
Enumeration Date:2008-05-26
Last Update Date:2008-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH1266156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30009726Medicaid
NH0912OtherEYE MED
18162OtherDAVIS VISION