Provider Demographics
NPI:1952517351
Name:WILKES PERALTA, HARRINGTON (OD)
Entity Type:Individual
Prefix:DR
First Name:HARRINGTON
Middle Name:
Last Name:WILKES PERALTA
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 1:35 CALLE SANTIAGO VIVALDI
Mailing Address - Street 2:
Mailing Address - City:YAUCO
Mailing Address - State:PR
Mailing Address - Zip Code:00698-3661
Mailing Address - Country:US
Mailing Address - Phone:787-856-3870
Mailing Address - Fax:787-856-3870
Practice Address - Street 1:35 CALLE SANTIAGO VIVALDI
Practice Address - Street 2:
Practice Address - City:YAUCO
Practice Address - State:PR
Practice Address - Zip Code:00698-3661
Practice Address - Country:US
Practice Address - Phone:787-856-3870
Practice Address - Fax:787-856-3870
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR494152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist