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Individual
RICHARD NELS PETERSEN
Active
Individual
RICHARD NELS PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0PT13129T
CA
152W00000X
Optometrist
13129
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14156
MESC
CA
01
—
SD13129T0
BLUECROSS/BLUE SHIELD
CA
Enumeration date
08/10/2006
Last updated
12/23/2008
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