MEDICARE: MR. DAVID ORRIN PETERS OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	3378TG	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00E51Z	OTHER	TX	BLUECROSSBLUESHIELDOFTEXA

General Provider Information

NPI Number	:	1073511838
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DAVID ORRIN PETERS OD

Provider Business Mailing Address
First Line	:	600 S COLORADO ST
Second Line	:
City	:	LOCKHART
State	:	TX
Zip	:	78644-3102
Country	:	US
Telephone Number	:	512-398-2020
Fax Number	:	512-398-5141

Provider Business Practice Location Address
First Line	:	600 S COLORADO ST
Second Line	:
City	:	LOCKHART
State	:	TX
Zip	:	78644-3102
Country	:	US
Telephone Number	:	512-398-2020
Fax Number	:	512-398-5141

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	02/03/2015

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