Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | TN3004 | TN |
NPI | 1013297852 |
---|---|
Provider Name | Mr. Anthony Vincent Perry |
First Address | Madison, TN 37115-2122 |
Second Address | Madison, TN 37115-2122 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2011 |
Last Update Date | 08/08/2016 |