Provider Demographics
NPI:1780731638
Name:PERRON, PAUL RENE (OD)
Entity type:Individual
Prefix:MR
First Name:PAUL
Middle Name:RENE
Last Name:PERRON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1213 PLEASANT GROVE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-6971
Mailing Address - Country:US
Mailing Address - Phone:916-789-1959
Mailing Address - Fax:916-789-1961
Practice Address - Street 1:1213 PLEASANT GROVE BLVD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-6989
Practice Address - Country:US
Practice Address - Phone:916-789-1959
Practice Address - Fax:916-789-1961
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10261T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist