Provider Demographics
NPI:1154466415
Name:PERRY JR., JOSEPH ALLEN (OD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ALLEN
Last Name:PERRY JR.
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 1:1700 HAMNER AVE
Mailing Address - Street 2:STE 102
Mailing Address - City:NORCO
Mailing Address - State:CA
Mailing Address - Zip Code:92860-2956
Mailing Address - Country:US
Mailing Address - Phone:951-735-7122
Mailing Address - Fax:
Practice Address - Street 1:1700 HAMNER AVE
Practice Address - Street 2:STE 102
Practice Address - City:NORCO
Practice Address - State:CA
Practice Address - Zip Code:92860-2956
Practice Address - Country:US
Practice Address - Phone:951-735-7122
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6772T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist