Provider Demographics
NPI:1528219391
Name:PETER J. VIOLETTE O.D.,P.C.
Entity Type:Organization
Organization Name:PETER J. VIOLETTE O.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:J
Authorized Official - Last Name:VIOLETTE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:781-245-3135
Mailing Address - Street 1:333 NORTH AVE
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-2300
Mailing Address - Country:US
Mailing Address - Phone:781-245-3135
Mailing Address - Fax:781-245-4518
Practice Address - Street 1:333 NORTH AVE
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:MA
Practice Address - Zip Code:01880-2300
Practice Address - Country:US
Practice Address - Phone:781-245-3135
Practice Address - Fax:781-245-4518
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-09
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3326152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0520420004Medicare NSC
MA0007711Medicare PIN