Provider Demographics
NPI:1487661914
Name:STEIN, PETER J (OD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:J
Last Name:STEIN
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 1:26 ARROWHEAD DR
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-3137
Mailing Address - Country:US
Mailing Address - Phone:203-453-6323
Mailing Address - Fax:203-453-8851
Practice Address - Street 1:590 NEW HAVEN AVE
Practice Address - Street 2:C/O PEARLE VISION
Practice Address - City:DERBY
Practice Address - State:CT
Practice Address - Zip Code:06418
Practice Address - Country:US
Practice Address - Phone:203-732-4916
Practice Address - Fax:203-735-4431
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002336152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTU44273Medicare UPIN
CT410000648Medicare ID - Type Unspecified