Individual
JEFFREY M PETERSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
8600 NICOLLET AVE S, MAIL STOP 31500A, BLOOMINGTON, MN 55420-2824
(952) 887-6600
(952) 886-7015
Mailing address
2019 JEFFERSON RD, STE A, NORTHFIELD, MN 55057-3258
(507) 645-9202
(507) 645-9203
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2567
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
989014900
—
MN
Enumeration date
02/02/2006
Last updated
04/21/2021
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