Provider Demographics
NPI:1992957252
Name:PERALA ENTERPRISES, LLC
Entity type:Organization
Organization Name:PERALA ENTERPRISES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:S
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:ABOC, FNAO
Authorized Official - Phone:307-632-1369
Mailing Address - Street 1:PO BOX 21676
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82003-7031
Mailing Address - Country:US
Mailing Address - Phone:307-632-1369
Mailing Address - Fax:307-632-2161
Practice Address - Street 1:6207 MISSILE DR
Practice Address - Street 2:BUILDING 722
Practice Address - City:FT WARREN AFB
Practice Address - State:WY
Practice Address - Zip Code:82005-2407
Practice Address - Country:US
Practice Address - Phone:307-632-1369
Practice Address - Fax:307-632-2161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier