Provider Demographics
NPI:1790740108
Name:KORPI, PETER L (OD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:L
Last Name:KORPI
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 1:315 PARHAM ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:MUSCATINE
Mailing Address - State:IA
Mailing Address - Zip Code:52761-2604
Mailing Address - Country:US
Mailing Address - Phone:563-263-7577
Mailing Address - Fax:563-263-7814
Practice Address - Street 1:315 PARHAM ST
Practice Address - Street 2:SUITE B
Practice Address - City:MUSCATINE
Practice Address - State:IA
Practice Address - Zip Code:52761-2604
Practice Address - Country:US
Practice Address - Phone:563-263-7577
Practice Address - Fax:563-263-7814
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1853152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA24139OtherWELLMARK BLUE CROSS
IA410016370OtherRR MEDICARE
IA0038497Medicaid
IAT01370Medicare UPIN
IA0517610001Medicare NSC
IA24139Medicare ID - Type Unspecified