1578728473 NPI number — DR PERRY L AMERINE PA

Table of content: (NPI 1578728473)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578728473 NPI number — DR PERRY L AMERINE PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR PERRY L AMERINE PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
AMERINE EYE CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578728473
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 26345
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITTLE ROCK
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72211
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
501-366-7299
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4120 EAST MCCAIN BLVD
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
NORTH LITTLE ROCK
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
501-223-2020
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/21/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
AMERINE
Authorized Official First Name:
PERRY
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
501-366-7299

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  2257 , registered in the state of AR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)