Provider Demographics
NPI:1790806057
Name:PIEPER, PETER JAY (OD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:JAY
Last Name:PIEPER
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 1:4211 PLUM CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-3090
Mailing Address - Country:US
Mailing Address - Phone:402-420-2431
Mailing Address - Fax:
Practice Address - Street 1:8700 ANDERMATT DR
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68526-9653
Practice Address - Country:US
Practice Address - Phone:402-484-6353
Practice Address - Fax:402-484-6372
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1040152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEU44279Medicare UPIN