Individual
WALTER PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
250 RED CLIFFS DR, ST GEORGE, UT 84790-8167
(435) 674-2020
(435) 674-3470
Mailing address
1901 PARKWAY BLVD, SALT LAKE CITY, UT 84119-2001
(801) 886-2020
(801) 954-0054
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1093699934
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
87017934025001
BLUE CROSS/BLUE SHIELD
UT
05
—
999000797009
—
UT
Enumeration date
10/12/2006
Last updated
07/26/2012
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