Provider Demographics
NPI:1245372010
Name:TOMAN, PETER BRETT (OD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:BRETT
Last Name:TOMAN
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 1:1245 WATER VIEW LN
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-6871
Mailing Address - Country:US
Mailing Address - Phone:434-441-0640
Mailing Address - Fax:
Practice Address - Street 1:1245 WATER VIEW LN
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-6871
Practice Address - Country:US
Practice Address - Phone:434-441-0640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2013-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000681152W00000X
GAOPT002749152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAOPT002749OtherOPTOMETRIC LICENSE
VA0618000681OtherTPA OPTOMETRIC LICENSE