MEDICARE: DR. HARRIET CAROLYN PELTON 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	HP002827	MI
2	152WC0802X	Corneal and Contact Management Optometrist	HP002827	MI

General Provider Information

NPI Number	:	1447332515
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HARRIET CAROLYN PELTON O.D.

Provider Business Mailing Address
First Line	:	4114 W MAPLE RD
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48301-3000
Country	:	US
Telephone Number	:	248-539-4800
Fax Number	:	248-539-4894

Provider Business Practice Location Address
First Line	:	4114 W MAPLE RD
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48301-3000
Country	:	US
Telephone Number	:	248-539-4800
Fax Number	:	248-539-4894

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

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	01/07/2008

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