Provider Demographics
NPI:1013620871
Name:PERL ENTERPRISE
Entity Type:Organization
Organization Name:PERL ENTERPRISE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALEXADER
Authorized Official - Middle Name:
Authorized Official - Last Name:PERL
Authorized Official - Suffix:
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:347-500-7174
Mailing Address - Street 1:142 S MAPLE AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-3353
Mailing Address - Country:US
Mailing Address - Phone:347-500-7174
Mailing Address - Fax:
Practice Address - Street 1:142 S MAPLE AVE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:PA
Practice Address - Zip Code:18704-3353
Practice Address - Country:US
Practice Address - Phone:347-500-7174
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-26
Last Update Date:2022-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty