Provider Demographics
NPI:1770815573
Name:ELIZABETH PEREZ, OD, PA
Entity Type:Organization
Organization Name:ELIZABETH PEREZ, OD, PA
Other - Org Name:MIRA VISION BOUTIQUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:361-387-5300
Mailing Address - Street 1:701 E HOUSTON ST
Mailing Address - Street 2:
Mailing Address - City:BEEVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78102-5023
Mailing Address - Country:US
Mailing Address - Phone:361-362-2020
Mailing Address - Fax:361-362-2030
Practice Address - Street 1:701 E HOUSTON ST
Practice Address - Street 2:
Practice Address - City:BEEVILLE
Practice Address - State:TX
Practice Address - Zip Code:78102-5023
Practice Address - Country:US
Practice Address - Phone:361-362-2020
Practice Address - Fax:361-362-2030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-03
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6662T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty