Provider Demographics
NPI:1043203078
Name:MOGYORDY, PETER V (OD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:V
Last Name:MOGYORDY
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 1:26927 DETROIT RD
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-2370
Mailing Address - Country:US
Mailing Address - Phone:440-892-5367
Mailing Address - Fax:440-249-5094
Practice Address - Street 1:26927 DETROIT RD
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-2370
Practice Address - Country:US
Practice Address - Phone:440-892-5367
Practice Address - Fax:440-249-5094
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4481152W00000X, 152WC0802X, 152WP0200X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHU45523Medicare UPIN