Provider Demographics
NPI:1730131392
Name:PETERS, DANIEL L (OD)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:L
Last Name:PETERS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1436 E 10TH ST
Mailing Address - Street 2:
Mailing Address - City:WINNER
Mailing Address - State:SD
Mailing Address - Zip Code:57580-2818
Mailing Address - Country:US
Mailing Address - Phone:605-842-1974
Mailing Address - Fax:605-842-2328
Practice Address - Street 1:1436 E 10TH ST
Practice Address - Street 2:
Practice Address - City:WINNER
Practice Address - State:SD
Practice Address - Zip Code:57580-2818
Practice Address - Country:US
Practice Address - Phone:605-842-1974
Practice Address - Fax:605-842-2328
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2013-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD110152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9201632Medicaid
SD100106Medicare ID - Type Unspecified
SD9201632Medicaid