Provider Demographics
NPI:1568431005
Name:PEER, CLYDE F (OD)
Entity Type:Individual
Prefix:
First Name:CLYDE
Middle Name:F
Last Name:PEER
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 1:521 WEBSTER ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH BOSTON
Mailing Address - State:VA
Mailing Address - Zip Code:24592-2429
Mailing Address - Country:US
Mailing Address - Phone:434-572-9500
Mailing Address - Fax:434-575-1333
Practice Address - Street 1:521 WEBSTER ST
Practice Address - Street 2:
Practice Address - City:SOUTH BOSTON
Practice Address - State:VA
Practice Address - Zip Code:24592-2429
Practice Address - Country:US
Practice Address - Phone:434-572-9500
Practice Address - Fax:434-575-1333
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0601000442152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAT86930Medicare UPIN