Provider Demographics
NPI:1891886941
Name:PEERY, JOHN STEPHEN (OD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:STEPHEN
Last Name:PEERY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:13128 MIDLOTHIAN TPKE
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113-4206
Mailing Address - Country:US
Mailing Address - Phone:804-378-2303
Mailing Address - Fax:804-378-1641
Practice Address - Street 1:13128 MIDLOTHIAN TPKE
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-4206
Practice Address - Country:US
Practice Address - Phone:804-378-2303
Practice Address - Fax:804-378-1641
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000103152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA140743OtherANTHEM
VAT83555Medicare UPIN
VA410000869Medicare PIN