Individual
DR. JAY D PETERSMA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
5501 NW 86TH ST, SUITE 500, JOHNSTON, IA 50131-1816
(515) 270-0494
(515) 270-6463
Mailing address
5501 NW 86TH ST, SUITE 500, JOHNSTON, IA 50131-1816
(515) 270-0494
(515) 270-6463
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
01861
IA
152WC0802X
Corneal and Contact Management Optometrist
01861
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18665
MIDLANDS CHOICE
IA
01
—
26387
WELLMARK
IA
Enumeration date
09/24/2006
Last updated
01/11/2010
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