Healthcare Provider Details

I. General information

NPI: 1336277110
Provider Name (Legal Business Name): PETER JOSEPH CALVI JR. O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 09/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7401 INTERSTATE HIGHWAY 30
GREENVILLE TX
75402-7121
US

IV. Provider business mailing address

7109 DALEWOOD LN
DALLAS TX
75214-1812
US

V. Phone/Fax

Practice location:
  • Phone: 903-455-1064
  • Fax:
Mailing address:
  • Phone: 214-827-2635
  • Fax: 214-827-3049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number4735T
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: