Provider Demographics
NPI:1992924088
Name:DR PETER L RICH OPTOMETRY CORP
Entity type:Organization
Organization Name:DR PETER L RICH OPTOMETRY CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:L
Authorized Official - Last Name:RICH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:949-362-2200
Mailing Address - Street 1:26611 ALISO CREEK RD
Mailing Address - Street 2:STE B
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-4805
Mailing Address - Country:US
Mailing Address - Phone:949-362-2200
Mailing Address - Fax:949-362-0249
Practice Address - Street 1:26611 ALISO CREEK RD
Practice Address - Street 2:STE B
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-4805
Practice Address - Country:US
Practice Address - Phone:949-362-2200
Practice Address - Fax:949-362-0249
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5453T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT70029Medicare UPIN