Individual
TAMMY HARTNETT PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
9055 SPRINGBROOK DR NW, COON RAPIDS, MN 55433-5841
(763) 780-9155
Mailing address
2925 CHICAGO AVE, MINNEAPOLIS, MN 55407-1321
(612) 262-5000
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1959
MN
152W00000X
Optometrist
1961-035
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
168223700
—
MN
Enumeration date
04/05/2006
Last updated
10/19/2011
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