Provider Demographics
NPI:1013074731
Name:PETERS, LOUIS J (OD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:J
Last Name:PETERS
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:11703 HUEBNER RD
Mailing Address - Street 2:SUITE 109
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-1201
Mailing Address - Country:US
Mailing Address - Phone:210-979-6440
Mailing Address - Fax:210-558-8310
Practice Address - Street 1:11703 HUEBNER RD
Practice Address - Street 2:SUITE 109
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-1201
Practice Address - Country:US
Practice Address - Phone:210-979-6440
Practice Address - Fax:210-558-8310
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX04858T152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU52634Medicare UPIN
TX82940EMedicare ID - Type Unspecified