Provider Demographics
NPI:1801855796
Name:EVERETT, PETER C (OD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:C
Last Name:EVERETT
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:PO BOX 310
Mailing Address - Street 2:
Mailing Address - City:RUMFORD
Mailing Address - State:ME
Mailing Address - Zip Code:04276-0310
Mailing Address - Country:US
Mailing Address - Phone:207-364-4491
Mailing Address - Fax:207-364-4015
Practice Address - Street 1:56 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:RUMFORD
Practice Address - State:ME
Practice Address - Zip Code:04276-2060
Practice Address - Country:US
Practice Address - Phone:207-364-4491
Practice Address - Fax:207-364-4015
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEOPT721152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist