Provider Demographics
NPI:1063941631
Name:PERRYMAN, SAMARA DUDLEY (OD)
Entity type:Individual
Prefix:DR
First Name:SAMARA
Middle Name:DUDLEY
Last Name:PERRYMAN
Suffix:
Gender:F
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 728
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:AL
Mailing Address - Zip Code:36081-0728
Mailing Address - Country:US
Mailing Address - Phone:334-566-2020
Mailing Address - Fax:
Practice Address - Street 1:606 S GEORGE WALLACE DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:AL
Practice Address - Zip Code:36081-3823
Practice Address - Country:US
Practice Address - Phone:334-566-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-D86152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist