Individual
DR. BALEY PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
966 HOUSTON NORTHCUTT BLVD, SUITE D, MOUNT PLEASANT, SC 29464-3487
(843) 881-2492
Mailing address
1481 CENTER STREET EXT APT 1001, MOUNT PLEASANT, SC 29464-4674
(712) 229-1508
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1741
SC
Other
Enumeration date
09/07/2012
Last updated
08/07/2013
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