Individual
DR. RENEE LYNN PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
200 MILLCREEK PLZ, ERIE, PA 16565-1102
(814) 864-4858
(814) 864-0398
Mailing address
1471 HENDERSONVILLE RD, SANDY LAKE, PA 16145-3419
(724) 376-3785
(814) 864-0398
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
PA OEG000497
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0075779450002
—
PA
01
—
084515
BLUE CROSS BLUE SHIELD
PA
01
—
397044
NAT'L VISION ADMINISTRATO
PA
01
—
50025
DAVIS VISION
PA
Enumeration date
10/16/2006
Last updated
12/16/2010
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