Individual
DR. LEON C PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
501 S WOODRUFF AVE, IDAHO FALLS, ID 83401-5200
(208) 522-6271
(208) 522-7217
Mailing address
501 S WOODRUFF AVE, IDAHO FALLS, ID 83401-5200
(208) 522-6271
(208) 522-7217
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP535
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1013943828
—
ID
Enumeration date
06/23/2006
Last updated
03/13/2014
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