Healthcare Provider Details

I. General information

NPI: 1295170538
Provider Name (Legal Business Name): ST. PETERS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2013
Last Update Date: 04/30/2013
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 Number3378-TG
License Number StateTX

VIII. Authorized Official

Name: DR. DAVID O. PETERS
Title or Position: OWNER
Credential: O.D.
Phone: 512-398-2020