Provider Demographics
NPI:1073189668
Name:FAYE L PETERS, OD LLC
Entity Type:Organization
Organization Name:FAYE L PETERS, OD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:FAYE
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:317-439-2344
Mailing Address - Street 1:3560 BRUMLEY MEWS
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46033-3022
Mailing Address - Country:US
Mailing Address - Phone:317-439-2344
Mailing Address - Fax:
Practice Address - Street 1:1250 N STATE ST
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:IN
Practice Address - Zip Code:46140-1055
Practice Address - Country:US
Practice Address - Phone:317-462-5949
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-03
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty