Provider Demographics
NPI:1720096860
Name:PEREZ, NANCY B (OD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:B
Last Name:PEREZ
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 1:1040 W HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18101-1069
Mailing Address - Country:US
Mailing Address - Phone:610-433-5128
Mailing Address - Fax:
Practice Address - Street 1:1040 W HAMILTON ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18101-1069
Practice Address - Country:US
Practice Address - Phone:610-433-5128
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001184152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA193883OtherBLUE SHIELD
PA314085OtherMERCY HEALTH PLAN
PAPE193883Medicare ID - Type Unspecified
PAT30069Medicare UPIN