Provider Demographics
NPI:1508335357
Name:PEREZ, LOUIS T (LDO4930)
Entity Type:Individual
Prefix:
First Name:LOUIS
Middle Name:T
Last Name:PEREZ
Suffix:
Gender:M
Credentials:LDO4930
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7472 BAY ST NE
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-5436
Mailing Address - Country:US
Mailing Address - Phone:727-254-1082
Mailing Address - Fax:
Practice Address - Street 1:4040 W WATERS AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-1958
Practice Address - Country:US
Practice Address - Phone:813-488-8231
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-21
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO4930156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician