Provider Demographics
NPI:1891724019
Name:PERICH, LARRY MICHAEL (DO)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:MICHAEL
Last Name:PERICH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 SEVEN SPRINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34655
Mailing Address - Country:US
Mailing Address - Phone:727-372-1311
Mailing Address - Fax:727-372-1972
Practice Address - Street 1:2020 SEVEN SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34655
Practice Address - Country:US
Practice Address - Phone:727-372-1311
Practice Address - Fax:727-372-1972
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-01
Last Update Date:2012-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0004040207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL061169700Medicaid
FL061169700Medicaid
FL180029544Medicare ID - Type UnspecifiedRAILROAD MEDICARE
FLD60615Medicare UPIN