Ryan Peterson O.D., Inc.

Primary specialty

OptometristTaxonomy code 152W00000X

License

532 Issued in NV

Legal business name

RYAN PETERSON O.D., INC.

Practice address

5691 Rickenbacker Rd
Nellis Afb, NV 89191-7052

Phone

(702) 644-6671

Fax

(702) 644-6682

NPI assigned

Jul 14, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Ryan Kent Peterson, O.D.

Title

Owner

Phone

(702) 644-6671

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• FAMILY FOCUSED EYECARE Doing business as

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Trang Ngo, O.D.

  • Optometrist
  • Las Vegas, NV
  • NPI 1558741355
  NPD (past)
• Sharon Tong, O.D.

  • Optometrist
  • Nellis Afb, NV
  • NPI 1457735953
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1152835200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1620172800000",
    "number": "1013933704",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9792",
            "city": "NELLIS AFB",
            "state": "NV",
            "postal_code": "891910792",
            "telephone_number": "702-644-6671",
            "fax_number": "702-444-0264"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5691 RICKENBACKER RD",
            "city": "NELLIS AFB",
            "state": "NV",
            "postal_code": "891917052",
            "telephone_number": "702-644-6671",
            "fax_number": "702-644-6682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RYAN PETERSON O.D., INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-14",
        "last_updated": "2021-05-05",
        "certification_date": "2021-05-05",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "RYAN",
        "authorized_official_middle_name": "KENT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "702-644-6671",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "NV",
            "license": "532",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100508599",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100506817",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "FAMILY FOCUSED EYECARE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Pamela Anna Rudnicki, MD
• Mellissa Ruiz
• Krystl Gayle Rumen, WHNP
• Elliot Runge, DO
• Joaniqua Rutherford, DENTAL ASSISTANT
• Ryan Peterson OD, Inc.
• Eda Saatciler, DNP-FNP, RN-BC, APN
• Leslie Hauser Sadler, LCSW, ACSW
• Adriana Cristina Saenz
• Safe Co-Management Inc

• Optometrist in Nellis Afb, NV
• Providers in Nellis Afb, NV by specialty
• Optometrist in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.