Provider Demographics
NPI:1558598870
Name:PETER L. EMER, O.D.
Entity Type:Organization
Organization Name:PETER L. EMER, O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:L
Authorized Official - Last Name:EMER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:262-652-1689
Mailing Address - Street 1:3612 ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-7230
Mailing Address - Country:US
Mailing Address - Phone:262-652-1689
Mailing Address - Fax:
Practice Address - Street 1:3612 ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-7230
Practice Address - Country:US
Practice Address - Phone:262-652-1689
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-12
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1725-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI0158970001Medicare NSC