Provider Demographics
NPI:1033240254
Name:NEHREBECKI, PETER ROBERT (OD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:ROBERT
Last Name:NEHREBECKI
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 1:240 SHOTWELL ST STE 206
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94110-1323
Mailing Address - Country:US
Mailing Address - Phone:415-621-5335
Mailing Address - Fax:415-552-3446
Practice Address - Street 1:240 SHOTWELL ST STE 206
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-1323
Practice Address - Country:US
Practice Address - Phone:415-621-5335
Practice Address - Fax:415-552-3446
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5312T152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0053120Medicaid
CASD0053120Medicare ID - Type Unspecified
CASD0053120Medicaid