Healthcare Provider Details

I. General information

NPI: 1144149113
Provider Name (Legal Business Name): JEFFREY W PETERS OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1444 S MICHIGAN AVE
CHICAGO IL
60605-4827
US

IV. Provider business mailing address

730 N MILWAUKEE AVE APT 1909
CHICAGO IL
60642-6036
US

V. Phone/Fax

Practice location:
  • Phone: 312-588-5999
  • Fax:
Mailing address:
  • Phone: 973-349-4654
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046.012115
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: