Provider Demographics
NPI:1710904610
Name:PETERSON, CHRISTOPHER H (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:H
Last Name:PETERSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2810 E TRINITY MILLS RD
Mailing Address - Street 2:173
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75006-2545
Mailing Address - Country:US
Mailing Address - Phone:972-416-1270
Mailing Address - Fax:972-416-4839
Practice Address - Street 1:2810 E TRINITY MILLS RD
Practice Address - Street 2:173
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75006-2545
Practice Address - Country:US
Practice Address - Phone:972-416-1270
Practice Address - Fax:972-416-4839
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6953TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
8L6550Medicare UPIN