Provider Demographics
NPI:1851482194
Name:PETERMAN, JESSE N (OD)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:N
Last Name:PETERMAN
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 1:2 W TALCOTT RD
Mailing Address - Street 2:LOSSMAN EYE CARE ASSOCIATES
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-5556
Mailing Address - Country:US
Mailing Address - Phone:630-674-7991
Mailing Address - Fax:
Practice Address - Street 1:1114 W DEVON AVE
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3214
Practice Address - Country:US
Practice Address - Phone:847-895-7222
Practice Address - Fax:847-895-0861
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046009781152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist