Provider Demographics
NPI:1992872287
Name:LERNER, PETER B (OD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:B
Last Name:LERNER
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 1:68 STONY HILL RD
Mailing Address - Street 2:
Mailing Address - City:BETHEL
Mailing Address - State:CT
Mailing Address - Zip Code:06801-3060
Mailing Address - Country:US
Mailing Address - Phone:203-797-8504
Mailing Address - Fax:203-797-1270
Practice Address - Street 1:68 STONY HILL RD
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:CT
Practice Address - Zip Code:06801-3060
Practice Address - Country:US
Practice Address - Phone:203-797-8504
Practice Address - Fax:203-797-1270
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000901152W00000X, 152WC0802X, 152WL0500X, 152WP0200X, 152WS0006X, 152WV0400X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTCT000901OtherCT LICENSE NUMBER
CT24874OtherCDS ST CONTROLLED SUB NUM
CT004110095Medicaid
CT004110095Medicaid
CT24874OtherCDS ST CONTROLLED SUB NUM
CT004110095Medicaid