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General NPI Number Information
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NPI Number | 1811900806
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Entity Type | Individual
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Provider Name | JOHN THEODORE PETROWSKI III O.D.
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Gender | Male
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Dates
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Enumeration Date | 08/14/2006
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Last Update Date | 10/23/2008
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Provider Practice Location Address
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Address Line | 2100 ERWIN RD
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City | DURHAM
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State | NC
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Zip | 27710-0001
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Country | US
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Telephone | 919-684-8111
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Fax |
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Provider Business Mailing Address
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Address Line | 4101 N ROXBORO ST
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City | DURHAM
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State | NC
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Zip | 27704-2121
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Country | US
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Telephone | 919-684-8111
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 0537
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License Number State | NH
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 0300000256
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License Number State | VT
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 1820
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License Number State | NC
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