Provider Demographics
NPI:1841259116
Name:AMERINE, PERRY (OD)
Entity type:Individual
Prefix:
First Name:PERRY
Middle Name:
Last Name:AMERINE
Suffix:
Gender:M
Credentials:OD
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 2427
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72203-2427
Mailing Address - Country:US
Mailing Address - Phone:501-375-6511
Mailing Address - Fax:501-375-8703
Practice Address - Street 1:11401 FINANCIAL CENTRE PKWY STE 101
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-3760
Practice Address - Country:US
Practice Address - Phone:501-219-0202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2007-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR2257152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
49153Medicare ID - Type Unspecified
T20284Medicare UPIN