Individual
DR. DONALD LEON PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
813 SW HIGHLAND AVE, REDMOND, OR 97756-3123
(541) 548-7170
Mailing address
813 SW HIGHLAND AVE, REDMOND, OR 97756-3123
(541) 548-7170
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1290T
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
236067
—
OR
01
—
A002
CHAMPUS
—
Enumeration date
08/11/2005
Last updated
12/17/2007
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