Provider Demographics
NPI:1467554436
Name:PETERS, LESTER G (OD)
Entity Type:Individual
Prefix:DR
First Name:LESTER
Middle Name:G
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 1:5644 BROOK RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23227-2273
Mailing Address - Country:US
Mailing Address - Phone:804-264-2956
Mailing Address - Fax:804-264-0447
Practice Address - Street 1:5644 BROOK RD
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23227-2273
Practice Address - Country:US
Practice Address - Phone:804-264-2956
Practice Address - Fax:804-264-0447
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2013-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000231152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA35004OtherDAVIS VISION
VA279166OtherANT;HEM BLUE CROSS
VA9232613Medicaid
VA35004OtherDAVIS VISION