Provider Demographics
NPI:1487725032
Name:PERKINS, BRETT WENDELL (OD)
Entity type:Individual
Prefix:DR
First Name:BRETT
Middle Name:WENDELL
Last Name:PERKINS
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 1:118 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PLACERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95667-5508
Mailing Address - Country:US
Mailing Address - Phone:530-622-8300
Mailing Address - Fax:530-622-8304
Practice Address - Street 1:118 MAIN ST
Practice Address - Street 2:
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-5508
Practice Address - Country:US
Practice Address - Phone:530-622-8300
Practice Address - Fax:530-622-8304
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2025-05-05
Deactivation Date:2025-03-31
Deactivation Code:
Reactivation Date:2025-05-02
Provider Licenses
StateLicense IDTaxonomies
UT111170-9933152W00000X
CACA 7653T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7653TOtherCALIFORNIA OPTOMETRY LICE
UT111170-9933OtherUT OPTOMETRY LICENSE
CASD0076530Medicaid
SD0076530Medicare ID - Type UnspecifiedMEDICARE NUMBER
UT111170-9933OtherUT OPTOMETRY LICENSE