Healthcare Provider Details

I. General information

NPI: 1932955978
Provider Name (Legal Business Name): PETER JAMES ANDERTON OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/29/2024
Last Update Date: 07/12/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 SW EMIGRANT AVE
PENDLETON OR
97801-1843
US

IV. Provider business mailing address

1815 SW EMIGRANT AVE
PENDLETON OR
97801-1843
US

V. Phone/Fax

Practice location:
  • Phone: 541-276-3653
  • Fax:
Mailing address:
  • Phone: 541-276-3653
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberATI4727
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: