Provider Demographics
NPI:1437190105
Name:PETERS, GREGG WILLIAM (OD)
Entity Type:Individual
Prefix:DR
First Name:GREGG
Middle Name:WILLIAM
Last Name:PETERS
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 1:1600 6TH AVE
Mailing Address - Street 2:SUITE 113
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-2626
Mailing Address - Country:US
Mailing Address - Phone:717-718-2393
Mailing Address - Fax:717-718-7150
Practice Address - Street 1:1600 6TH AVE
Practice Address - Street 2:SUITE 113
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17403-2626
Practice Address - Country:US
Practice Address - Phone:717-718-2393
Practice Address - Fax:717-718-7150
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002039152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019584700001Medicaid
PAPE142853Medicare ID - Type Unspecified