Provider Demographics
NPI:1801188776
Name:VERNON PERYEA,OPTOMETRIST LLC
Entity type:Organization
Organization Name:VERNON PERYEA,OPTOMETRIST LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VERNON
Authorized Official - Middle Name:
Authorized Official - Last Name:PERYEA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:845-221-5310
Mailing Address - Street 1:PO BOX 426
Mailing Address - Street 2:
Mailing Address - City:HOPEWELL
Mailing Address - State:NY
Mailing Address - Zip Code:12533-0426
Mailing Address - Country:US
Mailing Address - Phone:845-221-5310
Mailing Address - Fax:845-226-1464
Practice Address - Street 1:61 FRONT ST
Practice Address - Street 2:
Practice Address - City:MILLBROOK
Practice Address - State:NY
Practice Address - Zip Code:12545-5961
Practice Address - Country:US
Practice Address - Phone:845-677-5012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-10
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006321-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYTUV0063211OtherLICENSE
NYTUV0063211OtherLICENSE
NY275078419OtherTAX ID
NYTUV0063211OtherLICENSE