Provider Demographics
NPI:1891759973
Name:PETERS, JEFFREY KEITH (OD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:KEITH
Last Name:PETERS
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 1:102 EAGLE DR
Mailing Address - Street 2:
Mailing Address - City:MILLIKEN
Mailing Address - State:CO
Mailing Address - Zip Code:80543-9623
Mailing Address - Country:US
Mailing Address - Phone:970-587-2726
Mailing Address - Fax:303-457-6123
Practice Address - Street 1:11245 HURON ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80234-2806
Practice Address - Country:US
Practice Address - Phone:303-457-6646
Practice Address - Fax:303-457-6123
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1174152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1891759973Medicaid
CO1891759973Medicare Oscar/Certification
CO1891759973Medicare UPIN
CO1891759973Medicare PIN
CO1891759973Medicaid