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NPI Code Detail

MEDICARE: DR. JEFFREY KEITH PETERS O.D.

MEDICARE: DR. JEFFREY KEITH PETERS 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
1152W00000XOptometrist1174CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1891759973
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JEFFREY KEITH PETERS O.D.
Provider Business Mailing Address
First Line : 102 EAGLE DR
Second Line :
City : MILLIKEN
State : CO
Zip : 80543-9623
Country : US
Telephone Number : 970-587-2726
Fax Number : 303-457-6123
Provider Business Practice Location Address
First Line : 11245 HURON ST
Second Line :
City : WESTMINSTER
State : CO
Zip : 80234-2806
Country : US
Telephone Number : 303-457-6646
Fax Number : 303-457-6123
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2006
Last Update Date : 11/12/2007

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