Provider Demographics
NPI:1942267414
Name:PERRY, MARK E (OD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:E
Last Name:PERRY
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 140932
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32814
Mailing Address - Country:US
Mailing Address - Phone:407-893-6222
Mailing Address - Fax:407-896-4200
Practice Address - Street 1:400 N BUMBY AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-6028
Practice Address - Country:US
Practice Address - Phone:407-893-6222
Practice Address - Fax:407-896-4200
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2014-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2097152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL19886OtherBLUE CROSS BLUE SHIELD
FL078218100Medicaid
FL19886OtherBLUE CROSS BLUE SHIELD
16653Medicare UPIN