Provider Demographics
NPI:1073691077
Name:PETERS, JAMIE STARR (OD)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:STARR
Last Name:PETERS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8235 UNIVERSITY AVE
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-9320
Mailing Address - Country:US
Mailing Address - Phone:619-461-4913
Mailing Address - Fax:619-465-5070
Practice Address - Street 1:8235 UNIVERSITY AVE
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-9320
Practice Address - Country:US
Practice Address - Phone:619-461-4913
Practice Address - Fax:619-465-5070
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10724T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOP10724Medicare PIN