Individual
DR. BLAKE ALLEN PETERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
2020 KEITH ST NW, CLEVELAND, TN 37311-1351
(423) 472-6517
(423) 476-8578
Mailing address
2020 KEITH ST NW, CLEVELAND, TN 37311-1351
(423) 472-6517
(423) 476-8578
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODT1031
TN
Other
Enumeration date
07/29/2005
Last updated
12/06/2007
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