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Individual

JASON PETERSEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
O.D.

Contact information

Practice address
307 S 1ST AVE, SANDPOINT, ID 83864-1201
(208) 263-8501
Mailing address
307 S 1ST AVE, SANDPOINT, ID 83864-1201
(208) 263-8501
(208) 263-9713

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP-100336
ID

Other

Enumeration date
05/28/2015
Last updated
05/06/2020
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