Provider Demographics
NPI:1902399298
Name:PETERS, JOSEPH CONNER (OD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:CONNER
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 1:1875 MIDDLE RD
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-3203
Mailing Address - Country:US
Mailing Address - Phone:563-359-4446
Mailing Address - Fax:563-359-0381
Practice Address - Street 1:1875 MIDDLE RD
Practice Address - Street 2:
Practice Address - City:BETTENDORF
Practice Address - State:IA
Practice Address - Zip Code:52722-3203
Practice Address - Country:US
Practice Address - Phone:563-359-4446
Practice Address - Fax:563-359-0381
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-11
Last Update Date:2018-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA092516152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty