MEDICARE: ST. PETERS, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	3378-TG	TX

General Provider Information

NPI Number	:	1295170538
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. PETERS, PLLC

Provider Business Mailing Address
First Line	:	600 S COLORADO ST
Second Line	:
City	:	LOCKHART
State	:	TX
Zip	:	78644-3102
Country	:	US
Telephone Number	:	512-398-2020
Fax Number	:	512-398-5141

Provider Business Practice Location Address
First Line	:	600 S COLORADO ST
Second Line	:
City	:	LOCKHART
State	:	TX
Zip	:	78644-3102
Country	:	US
Telephone Number	:	512-398-2020
Fax Number	:	512-398-5141

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DAVID O. PETERS
Credential	:	O.D.
Telephone Number	:	512-398-2020

Provider Enumeration Date	:	04/30/2013
Last Update Date	:	04/30/2013

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