Provider Demographics
NPI:1851308555
Name:PERKA, THOMAS WILLIAM (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:WILLIAM
Last Name:PERKA
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 1:8 HILLTOP PLZ
Mailing Address - Street 2:
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201-8906
Mailing Address - Country:US
Mailing Address - Phone:724-545-2802
Mailing Address - Fax:
Practice Address - Street 1:8 HILLTOP PLZ
Practice Address - Street 2:
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-8906
Practice Address - Country:US
Practice Address - Phone:724-545-2802
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001339152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01724856Medicaid
PAPE805215OtherBLUE CROSS / BLUE SHIELD
PAPE805215OtherBLUE CROSS / BLUE SHIELD