Individual
DR. RICK E PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
5553 127TH ST, CRESTWOOD, IL 60445-1123
(708) 371-5160
(708) 930-1844
Mailing address
5553 127TH ST, CRESTWOOD, IL 60418-1123
(708) 371-5160
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046008476
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0514170001
MEDICARE DME GROUP
IL
01
—
0514170002
MEDICARE DME GROUP
IL
01
—
203865
MEDICARE GROUP
IL
01
—
203866
MEDICARE GROUP
IL
01
—
DA0515
MEDICARE RR GROUP
IL
01
—
DA0516
MEDICARE RR GROUP
IL
01
—
L95316
MEDICARE INDIVIDUAL
IL
01
—
L95317
MEDICARE INDIVIDUAL
IL
01
—
P00005574
MEDICARE RR
IL
01
—
P00005582
MEDICARE RR
IL
Enumeration date
09/27/2006
Last updated
02/18/2020
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