Individual
JOHN THEODORE PETROWSKI III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2100 ERWIN RD, DURHAM, NC 27710-0001
(919) 684-8111
Mailing address
4101 N ROXBORO ST, DURHAM, NC 27704-2121
(919) 684-8111
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
0300000256
VT
152W00000X
Optometrist
0537
NH
152W00000X
Optometrist
Primary
1820
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0RE1567
—
VT
05
—
30003949
—
NH
Enumeration date
08/14/2006
Last updated
10/23/2008
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