Provider Demographics
NPI:1669628806
Name:JOHN S. PEERY OPTOMETRIST P.C.
Entity Type:Organization
Organization Name:JOHN S. PEERY OPTOMETRIST P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:PEERY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:804-378-2303
Mailing Address - Street 1:13128 MIDLOTHIAN TPKE
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-4206
Mailing Address - Country:US
Mailing Address - Phone:804-378-2303
Mailing Address - Fax:804-378-1641
Practice Address - Street 1:13128 MIDLOTHIAN TPKE
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-4206
Practice Address - Country:US
Practice Address - Phone:804-378-2303
Practice Address - Fax:804-378-1641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-07
Last Update Date:2014-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA140743OtherANTHEM
VA140743OtherANTHEM
VAT83555Medicare UPIN
VADQ1309Medicare PIN
VAC11013Medicare PIN