Individual
BRAYDEN PETERSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
307 S 1ST AVE, SANDPOINT, ID 83864-1201
(208) 263-8501
Mailing address
307 S 1ST AVE, SANDPOINT, ID 83864-1201
(208) 263-8501
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
OD60970822
WA
152W00000X
Optometrist
Primary
ODP100472
ID
Other
Enumeration date
06/05/2019
Last updated
08/08/2019
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