Provider Demographics
NPI:1972346120
Name:PETERSON, ASHLEY ELIZABETH (OD)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:ELIZABETH
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 1:101 BREATHITT AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40422-8362
Mailing Address - Country:US
Mailing Address - Phone:859-550-0185
Mailing Address - Fax:
Practice Address - Street 1:104 SMOKY WAY STE 100
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:KY
Practice Address - Zip Code:40422-8729
Practice Address - Country:US
Practice Address - Phone:859-236-8644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYNA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist