Provider Demographics
NPI:1104071059
Name:PETER P. APPELL, O.D.,P.C.
Entity type:Organization
Organization Name:PETER P. APPELL, O.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:APPELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:507-523-2960
Mailing Address - Street 1:20760 ENTERPRISE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:LEWISTON
Mailing Address - State:MN
Mailing Address - Zip Code:55952-4249
Mailing Address - Country:US
Mailing Address - Phone:507-523-2960
Mailing Address - Fax:
Practice Address - Street 1:1798 OLD STAGE RD
Practice Address - Street 2:
Practice Address - City:DECORAH
Practice Address - State:IA
Practice Address - Zip Code:52101-7302
Practice Address - Country:US
Practice Address - Phone:563-382-1770
Practice Address - Fax:563-382-4928
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-19
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02284152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI11922Medicare PIN
IAU99246Medicare UPIN