Michael S Peterson, Od, Pc | |
1553 Gregson Ave, Salt Lake City, UT 84106-3419 | |
(801) 879-8721 | |
Not Available |
Full Name | Michael S Peterson, Od, Pc |
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Type | Facility |
Speciality | Optometrist |
Location | 1553 Gregson Ave, Salt Lake City, Utah |
Accepts Medicare Assignments | Medicare enrolled and accepts medicare insurance. Providers at this facility may prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1942437058 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
152W00000X | Optometrist | 283356-9934 (Utah) | Primary |
Provider Name | Michael S Peterson |
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Provider Type | Practitioner - Optometry |
Provider Identifiers | NPI Number: 1528020955 PECOS PAC ID: 0345278131 Enrollment ID: I20090612000171 |
Mailing Address | Practice Location Address |
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Michael S Peterson, Od, Pc 1553 Gregson Ave, Salt Lake City, UT 84106-3419 Ph: (801) 879-8721 | Michael S Peterson, Od, Pc 1553 Gregson Ave, Salt Lake City, UT 84106-3419 Ph: (801) 879-8721 |
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