Organization
PBR OPTOMETRISTS LTD OF SPRINGFIELD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEVEN J PETERSON OD (DIRECT OWNER)
(507) 629-3230
Entity
Organization
Contact information
Practice address
602 NORTH JACKSON AVE, SPRINGFIELD, MN 56087-0186
(507) 723-5115
(507) 723-6480
Mailing address
602 NORTH JACKSON AVE, PO BOX 186, SPRINGFIELD, MN 56087-0186
(507) 723-5115
(507) 723-6480
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
112984
UCARE
MN
01
—
3C276PB
BLUE PLUS
MN
01
—
3C276PB
BLUECROSS BLUESHIELD
—
01
—
43233PB
BCBS
MN
01
—
898861020124
PREFERRED ONE
MN
Enumeration date
01/23/2007
Last updated
04/18/2008
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