Provider Demographics
NPI:1275024093
Name:CYNTHIA L. PEETERSE, OD,LLC
Entity Type:Organization
Organization Name:CYNTHIA L. PEETERSE, OD,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PEETERSE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:850-516-9173
Mailing Address - Street 1:2220 TIDEWATER DR
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32583-3354
Mailing Address - Country:US
Mailing Address - Phone:850-516-9173
Mailing Address - Fax:
Practice Address - Street 1:1187 JOHN SIMS PKWY E
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-2752
Practice Address - Country:US
Practice Address - Phone:850-678-8876
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3504152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty