Provider Demographics
NPI:1659323210
Name:SILVER, PETER A (OD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:A
Last Name:SILVER
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 1:65 EDGEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06907-2610
Mailing Address - Country:US
Mailing Address - Phone:203-249-7043
Mailing Address - Fax:
Practice Address - Street 1:1455 E PUTNAM AVE
Practice Address - Street 2:
Practice Address - City:OLD GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06870-1360
Practice Address - Country:US
Practice Address - Phone:203-348-7575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2022-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002290152W00000X
NYTUV005194-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004245157Medicaid
CT004245157Medicaid
T31047Medicare UPIN