Provider Demographics
NPI:1922015627
Name:THOMAS W. PERKA OD LLC
Entity Type:Organization
Organization Name:THOMAS W. PERKA OD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:PERKA
Authorized Official - Suffix:
Authorized Official - Credentials:O D
Authorized Official - Phone:724-545-2802
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-02
Last Update Date:2016-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001339152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPE1514357OtherBLUE CROSS BLUE SHIELD