Provider Demographics
NPI:1568774099
Name:THAYER, PETER JAMES (OD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:JAMES
Last Name:THAYER
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 1:2912 35TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50310-4003
Mailing Address - Country:US
Mailing Address - Phone:515-451-4241
Mailing Address - Fax:
Practice Address - Street 1:2135 SE DELAWARE AVE
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50021-4592
Practice Address - Country:US
Practice Address - Phone:515-964-0444
Practice Address - Fax:515-964-7070
Is Sole Proprietor?:No
Enumeration Date:2010-07-13
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2493152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist