Provider Demographics
NPI:1821028879
Name:BUKEAVICH, A. PETER JR (OD)
Entity Type:Individual
Prefix:DR
First Name:A.
Middle Name:PETER
Last Name:BUKEAVICH
Suffix:JR
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 1:145 KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:MARTIN
Mailing Address - State:TN
Mailing Address - Zip Code:38237-3340
Mailing Address - Country:US
Mailing Address - Phone:731-587-2020
Mailing Address - Fax:731-587-4015
Practice Address - Street 1:145 KENNEDY DR
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:TN
Practice Address - Zip Code:38237-3340
Practice Address - Country:US
Practice Address - Phone:731-587-2020
Practice Address - Fax:731-587-4015
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNOD-1138 T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0362490001Medicare NSC
TN3596359Medicare PIN
TNT-61307Medicare UPIN