MEDICARE: PETERS EYE CARE, INC.

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	04858T	TX
2	152WC0802X	Corneal and Contact Management Optometrist	04858T	TX

General Provider Information

NPI Number	:	1821155409
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PETERS EYE CARE, INC.

Provider Business Mailing Address
First Line	:	11703 HUEBNER RD
Second Line	:	SUITE 109
City	:	SAN ANTONIO
State	:	TX
Zip	:	78230-1201
Country	:	US
Telephone Number	:	210-979-6440
Fax Number	:	210-558-8310

Provider Business Practice Location Address
First Line	:	11703 HUEBNER RD
Second Line	:	SUITE 109
City	:	SAN ANTONIO
State	:	TX
Zip	:	78230-1201
Country	:	US
Telephone Number	:	210-979-6440
Fax Number	:	210-558-8310

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LOUIS J PETERS
Credential	:	O.D.
Telephone Number	:	210-979-6440

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	12/13/2007

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