Peterson, Leon C

Peterson, Leon C is an individual health care provider with primary practice located at 501 S Woodruff Ave , Idaho Falls ID 83401-5200. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Peterson, Leon C can be contacted via phone (208) 522-6271.

Contact Information

Primary practice address
501 S Woodruff Ave Idaho Falls ID 83401-5200
Phone: (208) 522-6271
Fax: (208) 522-7217
Website:
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Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optometrist 152W00000X ODP535 Idaho

Profile Details

NPI number 1013943828
LBN Legal business name Peterson, Leon C
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 23rd, 2006
Last updated Mar 13th, 2014 - about 11 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 1013943828 NPPES
Idaho MEDICAID 1013943828

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