MEDICARE: DR. CAROLINE THERESE PETERSON O.D.

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	2393	NC

General Provider Information

NPI Number	:	1134520687
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROLINE THERESE PETERSON O.D.

Provider Business Mailing Address
First Line	:	344 S COLLEGE RD
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-1632
Country	:	US
Telephone Number	:	630-267-3491
Fax Number	:

Provider Business Practice Location Address
First Line	:	344 S COLLEGE RD
Second Line	:
City	:	WILMINGTON
State	:	NC
Zip	:	28403-1632
Country	:	US
Telephone Number	:	630-267-3491
Fax Number	:

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

Provider Enumeration Date	:	09/15/2014
Last Update Date	:	09/15/2014

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