Provider Demographics
NPI:1659395192
Name:PETERS, FARIHA (OD)
Entity Type:Individual
Prefix:
First Name:FARIHA
Middle Name:
Last Name:PETERS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:FARIHA
Other - Middle Name:
Other - Last Name:WALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:2525 US HIGHWAY 70 SE
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28602-8302
Mailing Address - Country:US
Mailing Address - Phone:828-322-1944
Mailing Address - Fax:
Practice Address - Street 1:2266 US HIGHWAY 70 SE
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28602-8302
Practice Address - Country:US
Practice Address - Phone:828-322-1944
Practice Address - Fax:828-324-0331
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11543 T152W00000X
NC1722152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0115430Medicaid
CAWOP11543AMedicare PIN
CASD0115430Medicaid