Provider Demographics
NPI:1902357791
Name:PERKINS, BOSTON (OD)
Entity Type:Individual
Prefix:
First Name:BOSTON
Middle Name:
Last Name:PERKINS
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 1:1945 W PALMETTO ST
Mailing Address - Street 2:SUITE 111
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-3919
Mailing Address - Country:US
Mailing Address - Phone:843-679-1812
Mailing Address - Fax:
Practice Address - Street 1:1945 W PALMETTO ST
Practice Address - Street 2:SUITE 111
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-3919
Practice Address - Country:US
Practice Address - Phone:843-679-1812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-17
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1968152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management