Provider Demographics
NPI:1184065526
Name:PERRY, COURTNEY D (OD)
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:D
Last Name:PERRY
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:D
Other - Last Name:FAUBION
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3415 GOLDEN RD
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-8355
Mailing Address - Country:US
Mailing Address - Phone:903-526-0444
Mailing Address - Fax:903-595-6650
Practice Address - Street 1:3415 GOLDEN RD
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-8355
Practice Address - Country:US
Practice Address - Phone:903-526-0444
Practice Address - Fax:903-595-6650
Is Sole Proprietor?:No
Enumeration Date:2013-07-15
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8175152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist