Provider Demographics
NPI:1427666973
Name:PETERSON, BAILEY (OD)
Entity type:Individual
Prefix:DR
First Name:BAILEY
Middle Name:
Last Name:PETERSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3880 TAMIAMI TRL N
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-3504
Mailing Address - Country:US
Mailing Address - Phone:239-659-3937
Mailing Address - Fax:239-659-3984
Practice Address - Street 1:3880 TAMIAMI TRL N
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-3504
Practice Address - Country:US
Practice Address - Phone:239-659-3937
Practice Address - Fax:239-659-3984
Is Sole Proprietor?:No
Enumeration Date:2020-07-21
Last Update Date:2020-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC005841152W00000X
MO2019021906152W00000X
FLOPC5841207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No152W00000XEye and Vision Services ProvidersOptometrist