Provider Demographics
NPI:1972696995
Name:BABCOCK, PETER (OD)
Entity type:Individual
Prefix:MR
First Name:PETER
Middle Name:
Last Name:BABCOCK
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 1:4150 BAIN AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-4547
Mailing Address - Country:US
Mailing Address - Phone:831-462-4624
Mailing Address - Fax:
Practice Address - Street 1:700 W KENT AVE
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-6772
Practice Address - Country:US
Practice Address - Phone:406-541-3937
Practice Address - Fax:406-541-3811
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK11576152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKSD0115760Medicare ID - Type Unspecified
AKU84905Medicare UPIN