Provider Demographics
NPI:1861756454
Name:MORENO, CARMEN PEREZ (OD)
Entity type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:PEREZ
Last Name:MORENO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7257 MILFORD ST
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95822-4622
Mailing Address - Country:US
Mailing Address - Phone:916-772-8804
Mailing Address - Fax:
Practice Address - Street 1:1125 GALLERIA BLVD
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-1935
Practice Address - Country:US
Practice Address - Phone:916-772-8804
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14441152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist