Provider Demographics
NPI:1891842241
Name:PEREZ AND PEREZ MDS PA
Entity Type:Organization
Organization Name:PEREZ AND PEREZ MDS PA
Other - Org Name:INTERNATIONAL EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MAGGIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHIDDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-875-6588
Mailing Address - Street 1:4506 WISHART PL
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-2724
Mailing Address - Country:US
Mailing Address - Phone:813-875-6588
Mailing Address - Fax:813-873-3688
Practice Address - Street 1:4506 WISHART PL
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-2724
Practice Address - Country:US
Practice Address - Phone:813-875-6588
Practice Address - Fax:813-873-3688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL4883160001Medicare NSC