Provider Demographics
NPI:1427890284
Name:PERLMUTTER, TANISHA (OD)
Entity type:Individual
Prefix:
First Name:TANISHA
Middle Name:
Last Name:PERLMUTTER
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 1:1020 TERRACE DR STE 100
Mailing Address - Street 2:
Mailing Address - City:MARION
Mailing Address - State:VA
Mailing Address - Zip Code:24354-4392
Mailing Address - Country:US
Mailing Address - Phone:276-783-5157
Mailing Address - Fax:276-783-5159
Practice Address - Street 1:1020 TERRACE DR STE 100
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:VA
Practice Address - Zip Code:24354-4392
Practice Address - Country:US
Practice Address - Phone:276-783-5157
Practice Address - Fax:276-783-5159
Is Sole Proprietor?:No
Enumeration Date:2024-06-11
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618003410152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist