A. Peter Bukeavich Jr., O.D.
Individual provider Active NPI Optometrist · Martin, TN
NPI 1821028879 · NPPES record last updated Jul 29, 2008
Key facts
- NPI
- 1821028879
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- OD-1138 T (TN)
- Practice address
- 145 Kennedy Dr
Martin, TN 38237-3340 - Phone
- (731) 587-2020
- Fax
- (731) 587-4015
- NPI assigned
- Jul 4, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OD-1138 T | TN | MD | Optometrist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | OD-1138 T | TN | Yes |
Addresses
Primary practice location
145 Kennedy Dr
Martin, TN 38237-3340
Mailing address
145 Kennedy Dr
Martin, TN 38237-3340
Phone (731) 587-2020
Other providers in Martin, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 29, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.