Provider Demographics
NPI:1447332515
Name:PELTON, HARRIET CAROLYN (OD)
Entity type:Individual
Prefix:DR
First Name:HARRIET
Middle Name:CAROLYN
Last Name:PELTON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MRS
Other - First Name:HARRIET
Other - Middle Name:CAROLYN
Other - Last Name:SNIDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4114 W MAPLE RD
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48301-3000
Mailing Address - Country:US
Mailing Address - Phone:248-539-4800
Mailing Address - Fax:248-539-4894
Practice Address - Street 1:4114 W MAPLE RD
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48301-3000
Practice Address - Country:US
Practice Address - Phone:248-539-4800
Practice Address - Fax:248-539-4894
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2008-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIHP002827152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIT33477Medicare UPIN
1051640001Medicare NSC