Provider Demographics
NPI:1194710988
Name:EMER, PETER L (OD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:L
Last Name:EMER
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 1:3612 ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-7230
Mailing Address - Country:US
Mailing Address - Phone:262-652-1689
Mailing Address - Fax:262-652-4345
Practice Address - Street 1:3612 ROOSEVELT RD
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-7230
Practice Address - Country:US
Practice Address - Phone:262-652-1689
Practice Address - Fax:262-652-4345
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-17
Last Update Date:2008-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1725-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38521900Medicaid
WI87449Medicare ID - Type Unspecified
WI0158970001Medicare NSC
WI38521900Medicaid