Provider Demographics
NPI:1992852776
Name:PEREIRA, ANITA M (OD)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:M
Last Name:PEREIRA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:739 ULLOA ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94127-1114
Mailing Address - Country:US
Mailing Address - Phone:415-664-3643
Mailing Address - Fax:
Practice Address - Street 1:255 HILLSDALE MALL
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-3410
Practice Address - Country:US
Practice Address - Phone:650-578-8520
Practice Address - Fax:650-571-7258
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10397T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU63683Medicare UPIN