Provider Demographics
NPI:1407145485
Name:JAMISON, PETER L (OD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:L
Last Name:JAMISON
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 1:60 ALSTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06515-2701
Mailing Address - Country:US
Mailing Address - Phone:203-605-9573
Mailing Address - Fax:
Practice Address - Street 1:60 ALSTON AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06515-2701
Practice Address - Country:US
Practice Address - Phone:203-605-9573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-30
Last Update Date:2011-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001015152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist