Provider Demographics
NPI:1952393779
Name:VISHTON, PETER J (OD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:J
Last Name:VISHTON
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 1:2 DUCK POND CT
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-3686
Mailing Address - Country:US
Mailing Address - Phone:856-627-2020
Mailing Address - Fax:856-627-2020
Practice Address - Street 1:26 GENESEE ST
Practice Address - Street 2:
Practice Address - City:CUBA
Practice Address - State:NY
Practice Address - Zip Code:14727-1115
Practice Address - Country:US
Practice Address - Phone:585-968-2210
Practice Address - Fax:856-627-2020
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV0035251152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0433900001OtherNSC
NYT88394Medicare UPIN
NY079101Medicare ID - Type Unspecified