Provider Demographics
NPI:1548250053
Name:PEREZ, LIVIA IVETTE (OD)
Entity type:Individual
Prefix:DR
First Name:LIVIA
Middle Name:IVETTE
Last Name:PEREZ
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:13409 GANDALL CT
Mailing Address - Street 2:
Mailing Address - City:MANASSAS
Mailing Address - State:VA
Mailing Address - Zip Code:20112-5544
Mailing Address - Country:US
Mailing Address - Phone:703-794-1908
Mailing Address - Fax:
Practice Address - Street 1:WALTER REED ARMY MEDICAL CTR
Practice Address - Street 2:6900 GEORGIA AVE NW
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20307-0001
Practice Address - Country:US
Practice Address - Phone:202-782-6688
Practice Address - Fax:202-782-4913
Is Sole Proprietor?:No
Enumeration Date:2005-10-26
Last Update Date:2008-06-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR284152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist