Provider Demographics
NPI:1811284540
Name:PERICHI, LUCY NOEMI (OPTICO LICENCIADO)
Entity type:Individual
Prefix:MRS
First Name:LUCY
Middle Name:NOEMI
Last Name:PERICHI
Suffix:
Gender:F
Credentials:OPTICO LICENCIADO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1208
Mailing Address - Street 2:
Mailing Address - City:SAN GERMAN
Mailing Address - State:PR
Mailing Address - Zip Code:00683-1208
Mailing Address - Country:US
Mailing Address - Phone:787-673-3513
Mailing Address - Fax:
Practice Address - Street 1:27 CALLE CARBONELL
Practice Address - Street 2:
Practice Address - City:CABO ROJO
Practice Address - State:PR
Practice Address - Zip Code:00623-3547
Practice Address - Country:US
Practice Address - Phone:787-673-3513
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-01
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR469156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician