Leon C Peterson, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

ODP535 Issued in ID

Practice address

501 S Woodruff Ave
Idaho Falls, ID 83401-5200

Phone

(208) 522-6271

Fax

(208) 522-7217

NPI assigned

Jun 23, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in ID

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• For Your Eyes Only, LLC

  • Optometrist
  • Idaho Falls, ID
  • NPI 1407148109
  Medicare reassignment NPD
• Bingham Family Vision, LLC

  • Optometrist
  • Blackfoot, ID
  • NPI 1336624030
  NPD (past)
• River Valley Chiropractic PLLC

  • Chiropractor
  • Blackfoot, ID
  • NPI 1184056814
  NPD (past)

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

{
    "created_epoch": "1151020800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1394668800000",
    "number": "1013943828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 S WOODRUFF AVE",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834015200",
            "telephone_number": "208-522-6271",
            "fax_number": "208-522-7217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "501 S WOODRUFF AVE",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834015200",
            "telephone_number": "208-522-6271",
            "fax_number": "208-522-7217"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETERSON",
        "first_name": "LEON",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-23",
        "last_updated": "2014-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "ID",
            "license": "ODP535",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1013943828",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Corene Peterson, LCSW
• Malik Peterson, DO, DO
• Emily Peterson
• Jason M Peterson, DDS
• Jennifer Rae Peterson, LMSW
• Marissa Peterson, MA/CCC-SLP
• Russell Henry Peterson, M.S.
• Pettingill Counseling PC
• Pettingill Counseling Services
• Pettingill Counseling Services, PC

• Optometrist in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Optometrist in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.