Provider Demographics
NPI:1710029160
Name:PETERS, DEXEL (OD)
Entity Type:Individual
Prefix:DR
First Name:DEXEL
Middle Name:
Last Name:PETERS
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 1:144 KARLSRUHE STRASSE
Mailing Address - Street 2:BLDG 3617, OPTOMETRY
Mailing Address - City:HEIDELBERG
Mailing Address - State:BADEN-WURTTEMBERG
Mailing Address - Zip Code:69123
Mailing Address - Country:DE
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:144 KARLSRUHE STRASSE
Practice Address - Street 2:BLDG 3617, OPTOMETRY
Practice Address - City:HEIDELBERG
Practice Address - State:BADEN-WURTTEMBERG
Practice Address - Zip Code:69123
Practice Address - Country:DE
Practice Address - Phone:01149622-117-3407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3000152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist