Provider Demographics
NPI:1982734653
Name:PHILIP M PERRINO P.C.
Entity Type:Organization
Organization Name:PHILIP M PERRINO P.C.
Other - Org Name:ROYAL VISION ASSOCIATES OR DURHAM FAMILY EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:M
Authorized Official - Last Name:PERRINO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:203-865-6727
Mailing Address - Street 1:815 CHAPEL ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-3001
Mailing Address - Country:US
Mailing Address - Phone:203-865-6727
Mailing Address - Fax:203-865-8040
Practice Address - Street 1:815 CHAPEL ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-3001
Practice Address - Country:US
Practice Address - Phone:203-865-6727
Practice Address - Fax:203-865-8040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002286152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTOV5752OtherHEALTHNET
CTP1003065OtherOXFORD
CT910087OtherBLOCK VISION
CT183826OtherWELLCARE
CT090002286CT06OtherBLUE CROSS BLUE SHIELD
CT09878OtherSPECTERA
CT115060OtherEYEMED
CT004149721Medicaid
CT004149721Medicaid
CT1305140001Medicare NSC
CT910087OtherBLOCK VISION