Individual
DR. BRIAN MICHAEL PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
900 W GRANADA BLVD STE 1, ORMOND BEACH, FL 32174-5941
(386) 675-6599
Mailing address
1857 OLD TOMOKA RD W, ORMOND BEACH, FL 32174-6704
(386) 986-7997
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPC 4830
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OPC 4830
FLORIDA LICENSE NUMBER
FL
Enumeration date
08/22/2013
Last updated
07/09/2026
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