Organization
PBR OPTOMETRISTS LTD OF TRACY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STEVEN J PETERSON OD (DIRECT OWNER OF 5 PERCENT OR MORE)
(507) 629-3230
Entity
Organization
Contact information
Practice address
505 STATE STREET, TRACY, MN 56175-1539
(507) 629-3230
(507) 629-3230
Mailing address
505 STATE STREET, TRACY, MN 56175-1539
(507) 629-3230
(507) 629-3230
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
112433
UCARE
MN
01
—
410011573
RAILROAD MC
—
01
—
46047PB
BCBS
MN
01
—
47621
HEALTH PARTNERS
MN
01
—
5C048PB
BLUE PLUS
MN
05
—
697823100
—
MN
01
—
942951013894
PREFERRED ONE
MN
Enumeration date
01/23/2007
Last updated
04/04/2008
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