Provider Demographics
NPI:1558373407
Name:ANDERSON, PETER KNOX (OD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:KNOX
Last Name:ANDERSON
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 1:71 CRABTREE DR
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19055-1617
Mailing Address - Country:US
Mailing Address - Phone:215-946-8478
Mailing Address - Fax:267-202-6887
Practice Address - Street 1:71 CRABTREE DR
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:PA
Practice Address - Zip Code:19055-1617
Practice Address - Country:US
Practice Address - Phone:215-946-8478
Practice Address - Fax:267-202-6887
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2014-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE 006503T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT72936Medicare UPIN
PA460307Medicare PIN
PA410014085Medicare PIN