MEDICARE: DR. ANDREW PETER O.D.

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	OPT T 306	AK

General Provider Information

NPI Number	:	1356660534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANDREW PETER O.D.

Provider Business Mailing Address
First Line	:	3726 LAKE ST STE A
Second Line	:
City	:	HOMER
State	:	AK
Zip	:	99603-7663
Country	:	US
Telephone Number	:	907-235-7745
Fax Number	:	907-235-7710

Provider Business Practice Location Address
First Line	:	3726 LAKE ST
Second Line	:
City	:	HOMER
State	:	AK
Zip	:	99603-7663
Country	:	US
Telephone Number	:	907-235-7745
Fax Number	:	907-235-7710

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2010
Last Update Date	:	07/30/2010

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