Provider Demographics
NPI:1194881383
Name:PEREY, DAVE SERAFICO (OD)
Entity type:Individual
Prefix:DR
First Name:DAVE
Middle Name:SERAFICO
Last Name:PEREY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1212 SANTA LUCIA RD
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-1502
Mailing Address - Country:US
Mailing Address - Phone:619-482-2328
Mailing Address - Fax:619-697-1786
Practice Address - Street 1:8125 FLETCHER PKWY
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-2934
Practice Address - Country:US
Practice Address - Phone:619-469-0450
Practice Address - Fax:619-697-1786
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10912T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist