Provider Demographics
NPI:1023064110
Name:JOHN C. PERLMUTTER, INC.
Entity type:Organization
Organization Name:JOHN C. PERLMUTTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:PERLMUTTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-434-0202
Mailing Address - Street 1:226 SOUTH WOODS MILL ROAD
Mailing Address - Street 2:SUITE 51 WEST
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017
Mailing Address - Country:US
Mailing Address - Phone:314-434-0202
Mailing Address - Fax:314-434-8950
Practice Address - Street 1:226 S WOODS MILL RD
Practice Address - Street 2:SUITE 51 WEST
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-3662
Practice Address - Country:US
Practice Address - Phone:314-434-0202
Practice Address - Fax:314-434-8950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2009-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMDR4662207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOA09939Medicare UPIN