Individual
GARY PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
591 LINCOLN ST, WORCESTER, MA 01605-1932
(508) 852-3636
Mailing address
591 LINCOLN ST, WORCESTER, MA 01604-1932
(508) 852-3636
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1972
MA
Other
Enumeration date
06/10/2009
Last updated
06/10/2009
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