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Contact Information

THOMAS G PETERSON, OD
150A COUNTY ROAD B
SHAWANO, WI54166
 Phone: 715-526-3163
 Fax: 715-526-4019
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Optometrist

152W00000X 41 Optometry
Indicates primary specialty

NPI Profile & details for THOMAS G PETERSON · (Male)

NPI Number 1114043387
Status Active
Credentials OD (Doctor of Optometry)
Entity Individual
Enumeration date 03/21/2007
Last updated 07/22/2018 - About 8 years ago
Sole proprietor 1 No
Identifiers
  • WI License # 2324
  • WI Medicaid 38578000
  • WI Other 410033786 RAILROAD MEDICARE
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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