Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | 04858T | TX |
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 04858T | TX |
NPI | 1013074731 |
---|---|
Provider Name | Dr. Louis J Peters |
First Address | San Antonio, TX 78230-1201 |
Second Address | San Antonio, TX 78230-1201 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2007 |
Last Update Date | 13/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U52634 | (02) | TX |