Provider Demographics
NPI:1518277136
Name:LARRY M. PERICH DOPA
Entity type:Organization
Organization Name:LARRY M. PERICH DOPA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADM
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:PERICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-372-1311
Mailing Address - Street 1:2020 SEVEN SPRINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-3933
Mailing Address - Country:US
Mailing Address - Phone:727-372-1311
Mailing Address - Fax:727-372-1972
Practice Address - Street 1:6905 MEDICAL VIEW LN
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33542-6648
Practice Address - Country:US
Practice Address - Phone:813-788-2020
Practice Address - Fax:813-788-2044
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LARRY M. PERICH DOPA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-15
Last Update Date:2010-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 4040152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty