Provider Demographics
NPI:1184935009
Name:DEGRAZIANO, PETER EDWIN (OD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:EDWIN
Last Name:DEGRAZIANO
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 1:9200 HARVEST OAK DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-9214
Mailing Address - Country:US
Mailing Address - Phone:540-322-3813
Mailing Address - Fax:
Practice Address - Street 1:3102 PLANK RD STE 600
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-4954
Practice Address - Country:US
Practice Address - Phone:540-786-3405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-24
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14132152W00000X
VA0618001181152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist