| Doctor Name: | MRS. BRANDY PETERSON |
| NPI Number: | 1366833865 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | A.B.O.C., N.C.L.E. |
| License Number: | 156379 |
| Business Practice Address: | 18511 South River Rd, Three Rivers, MI - 49093 |
| Business Phone Number: | 7346577543 |
| Business Fax Number: | |
| Mailing Address: | 18511 South River Rd,, THREE RIVERS |
| State: | MI |
| Postal Code: | 49093 |
| Phone Number: | |
| Fax Number: | |
| NPI Enumeration Date: | 02/05/2015 |
| NPI Last Update Date: | 02/05/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 156FC0801X |
| License Number: | 156379 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MI |
| Taxonomy Type: | Eye and Vision Services Providers |
| Taxonomy Classification: | Technician/Technologist |
| Taxonomy Specialization: | Contact Lens Fitter |
| Taxonomy Definition: | An optician or other ancillary support staff person who, where authorized by state law and trained or certified to do so, may fit or dispense contact lenses to a patient based on the prescription of an optometrist or medical physician. |