Provider Demographics
NPI:1821343484
Name:PETERSEN, MEGAN MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:MARIE
Last Name:PETERSEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2628 BEAVER AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50310-3908
Mailing Address - Country:US
Mailing Address - Phone:515-274-4141
Mailing Address - Fax:515-274-4144
Practice Address - Street 1:1620 SUPERIOR ST STE 3
Practice Address - Street 2:
Practice Address - City:WEBSTER CITY
Practice Address - State:IA
Practice Address - Zip Code:50595-2913
Practice Address - Country:US
Practice Address - Phone:515-832-2401
Practice Address - Fax:515-832-6393
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002544152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist