Provider Demographics
NPI:1518029693
Name:VISENDI, PETER S (OD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:S
Last Name:VISENDI
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 1:3464 CAMINO TASSAJARA
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94506-4680
Mailing Address - Country:US
Mailing Address - Phone:925-736-4911
Mailing Address - Fax:925-736-8272
Practice Address - Street 1:3464 CAMINO TASSAJARA
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94506-4680
Practice Address - Country:US
Practice Address - Phone:925-736-4911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5475T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist