Healthcare Provider Details

I. General information

NPI: 1073511838
Provider Name (Legal Business Name): DAVID ORRIN PETERS OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 02/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S COLORADO ST
LOCKHART TX
78644-3102
US

IV. Provider business mailing address

600 S COLORADO ST
LOCKHART TX
78644-3102
US

V. Phone/Fax

Practice location:
  • Phone: 512-398-2020
  • Fax: 512-398-5141
Mailing address:
  • Phone: 512-398-2020
  • Fax: 512-398-5141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3378TG
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: