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Individual
DR. RIC DONALD PETERSON
Active
Individual
DR. RIC DONALD PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4304
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
005FB
BCBSTX - GROUP#
TX
01
—
00Y945
NSC -MEDICARE GROUP PTAN#
TX
01
—
197166501
MEDICAID - GROUP TPI#
TX
05
—
329106401
—
TX
01
—
8DW848
BLUE CROSS BLUE SHIELD
TX
Enumeration date
05/22/2007
Last updated
06/21/2023
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