Organization
MICHAEL S PETERSON, OD, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL SHAWN PETERSON O.D. (PRESIDENT)
(801) 879-8721
Entity
Organization
Contact information
Practice address
1553 GREGSON AVE, SALT LAKE CITY, UT 84106-3419
(801) 879-8721
Mailing address
1553 GREGSON AVE, SALT LAKE CITY, UT 84106-3419
(801) 879-8721
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
283356-9934
UT
Other
Enumeration date
06/16/2009
Last updated
06/16/2009
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