Provider Demographics
NPI:1982784666
Name:PETERS, BENJAMIN P (OD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:P
Last Name:PETERS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:BENJAMIN
Other - Middle Name:P
Other - Last Name:PETERS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:2142 PENFIELD RD - EYESITE
Mailing Address - Street 2:
Mailing Address - City:PENFIELD
Mailing Address - State:NY
Mailing Address - Zip Code:14526
Mailing Address - Country:US
Mailing Address - Phone:585-377-7090
Mailing Address - Fax:585-377-3155
Practice Address - Street 1:2142 PENFIELD RD - EYESITE
Practice Address - Street 2:
Practice Address - City:PENFIELD
Practice Address - State:NY
Practice Address - Zip Code:14526
Practice Address - Country:US
Practice Address - Phone:585-377-7090
Practice Address - Fax:585-377-3155
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006900152W00000X
NYTUV006960152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYU98012Medicare UPIN