Provider Demographics
NPI:1881748283
Name:PEROZEK PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:PEROZEK PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:CERMINARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-982-1360
Mailing Address - Street 1:653 N TOWN CENTER DR
Mailing Address - Street 2:SUITE 212
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-0514
Mailing Address - Country:US
Mailing Address - Phone:702-982-1360
Mailing Address - Fax:702-202-3489
Practice Address - Street 1:653 N TOWN CENTER DR
Practice Address - Street 2:SUITE 212
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-0514
Practice Address - Country:US
Practice Address - Phone:702-982-1360
Practice Address - Fax:702-202-3489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11220207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV=========OtherTIN
NV=========OtherTIN