Peterson, Charles Walter

Peterson, Charles Walter is an sole proprietor health care provider with primary practice located at 904 Elliott Ave N , Wenatchee WA 98801-1666. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Peterson, Charles Walter can be contacted via phone (509) 860-2453.

Contact Information

Primary practice address
904 Elliott Ave N Wenatchee WA 98801-1666
Phone: (509) 860-2453
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X OD00003914 Washington
Eye and Vision Services Providers / Optometrist 152W00000X 697 Montana

Profile Details

NPI number 1902973415
LBN Legal business name Peterson, Charles Walter
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Nov 29th, 2006
Last updated Mar 9th, 2011 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1902973415 NPPES
Washington MEDICAID 2030641

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