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General NPI Number Information
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NPI Number | 1053825570
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Entity Type | Organization
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Legal Business Name | RICHARD M PETERS OD AN OPTOMETRIC CORPORATION
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Dates
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Enumeration Date | 11/20/2017
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Last Update Date | 11/20/2017
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Provider Practice Location Address
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Address Line | 810 N AVALON BLVD
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City | WILMINGTON
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State | CA
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Zip | 90744-4502
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Country | US
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Telephone | 310-834-5464
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Fax | 310-835-6665
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Provider Business Mailing Address
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Address Line | 810 N AVALON BLVD
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City | WILMINGTON
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State | CA
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Zip | 90744-4502
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Country | US
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Telephone | 310-834-5464
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Fax | 310-835-6665
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | MR. RICHARD MICHAEL PETERS
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Credential | OD
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Telephone | 310-834-5464
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 4741T
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License Number State | CA
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