MEDICARE: CLYDE F PEER 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	0601000442	VA

General Provider Information

NPI Number	:	1568431005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLYDE F PEER OD

Provider Business Mailing Address
First Line	:	521 WEBSTER ST
Second Line	:
City	:	SOUTH BOSTON
State	:	VA
Zip	:	24592-2429
Country	:	US
Telephone Number	:	434-572-9500
Fax Number	:	434-575-1333

Provider Business Practice Location Address
First Line	:	521 WEBSTER ST
Second Line	:
City	:	SOUTH BOSTON
State	:	VA
Zip	:	24592-2429
Country	:	US
Telephone Number	:	434-572-9500
Fax Number	:	434-575-1333

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

Provider Enumeration Date	:	03/16/2006
Last Update Date	:	03/15/2026

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