Provider Demographics
NPI:1003945296
Name:VIOLETTE, PETER JOHN (OD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:JOHN
Last Name:VIOLETTE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 NORTH AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-2300
Mailing Address - Country:US
Mailing Address - Phone:781-245-3135
Mailing Address - Fax:781-245-4518
Practice Address - Street 1:333 NORTH AVE
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-2300
Practice Address - Country:US
Practice Address - Phone:781-245-3135
Practice Address - Fax:781-245-4518
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2012-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3326152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW15753OtherBLUE CROSS AND BLUE SHIEL
MA15158-5OtherHARVARD PILGRIM
MA716213OtherTUFTS
MAW15753OtherBLUE CROSS AND BLUE SHIEL
MAT79630Medicare UPIN