Individual
DR. ANTHONY PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
150 E HIGHWAY 67, SUITE 120, DUNCANVILLE, TX 75137-4476
(972) 298-3937
(972) 298-2170
Mailing address
150 E HIGHWAY 67, SUITE 120, DUNCANVILLE, TX 75137-4476
(972) 298-3937
(972) 298-2170
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
7032TG
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
196604604
MEDICAID PROVIDER TPI#
TX
01
—
269216
MEDICARE PTAN
TX
Enumeration date
02/15/2007
Last updated
11/13/2013
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