Provider Demographics
NPI:1447600150
Name:PETERS, TAYLOR (OD)
Entity Type:Individual
Prefix:
First Name:TAYLOR
Middle Name:
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:PO BOX 146
Mailing Address - Street 2:
Mailing Address - City:MT STERLING
Mailing Address - State:OH
Mailing Address - Zip Code:43143-0146
Mailing Address - Country:US
Mailing Address - Phone:740-869-4882
Mailing Address - Fax:740-869-7698
Practice Address - Street 1:277 YANKEETOWN ST
Practice Address - Street 2:
Practice Address - City:MT STERLING
Practice Address - State:OH
Practice Address - Zip Code:43143-9410
Practice Address - Country:US
Practice Address - Phone:740-869-4882
Practice Address - Fax:740-869-7698
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-14
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6489152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist