Healthcare Provider Details

I. General information

NPI: 1336945773
Provider Name (Legal Business Name): BROOKE ELIZABETH PETERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BROOKE ELIZABETH SCHMIDT

II. Dates (important events)

Enumeration Date: 02/24/2025
Last Update Date: 07/04/2025
Certification Date: 07/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1116 SW US HIGHWAY 40
BLUE SPRINGS MO
64015-4610
US

IV. Provider business mailing address

111 E 4TH ST STE 440
ALTON IL
62002-6206
US

V. Phone/Fax

Practice location:
  • Phone: 816-229-2020
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2025024660
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: