Individual
LAURA VERWILST PERRON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
744 E 3RD ST, BLOOMINGTON, IN 47405-3603
(812) 855-8436
(812) 855-1683
Mailing address
2520 S BANTA AVE, BLOOMINGTON, IN 47403-3402
(574) 298-7748
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
046.010802
IL
152W00000X
Optometrist
Primary
18003918A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201312970
—
IN
Enumeration date
07/16/2014
Last updated
10/21/2015
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