Individual
DR. BERT M PETERSON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1126 E. LYNCHBURG-SALEM TPK, WALMART VISION CENTER, BEDFORD, VA 24523-3446
(540) 586-0111
(540) 586-0111
Mailing address
PO BOX 823, BEDFORD, VA 24523-0823
(540) 586-0111
(540) 586-0111
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0618000348
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
222702
LUXOTICA MANAGED CARE
VA
05
—
92-3065-3
—
VA
Enumeration date
09/07/2006
Last updated
07/18/2018
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