Healthcare Provider Details

I. General information

NPI: 1104939339
Provider Name (Legal Business Name): AMY L PETERSON OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY L CORBIN OD

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 11/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 MAIN ST
SAXONBURG PA
16056
US

IV. Provider business mailing address

PO BOX 500 324 MAIN ST
SAXONBURG PA
16056
US

V. Phone/Fax

Practice location:
  • Phone: 724-352-2433
  • Fax: 724-352-8466
Mailing address:
  • Phone: 724-352-2433
  • Fax: 724-352-8466

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOEG000390
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: