Individual provider · NPI-1

Dr. Thomas G Peterson, O.D.

Optometrist · Shawano, WI

NPI number1114043387
StatusActive
Last updated in NPPESJul 22, 2018

Details

NPI
1114043387
Entity type
Individual (NPI-1)
Name
Dr. Thomas G Peterson
Credential
O.D.
Sex
Male
Sole proprietor
No
Enumeration date
Mar 21, 2007
Last updated
Jul 22, 2018

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
152W00000X Optometrist2324WIYes

Practice location

150a County Road B
Shawano, WI 54166

Phone 715-526-3163 · Fax 715-526-4019

Mailing address

150a County Road B
Shawano, WI 54166-7072

Phone 715-526-3163 · Fax 715-526-4019

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