Peterson Optometric Group, PLLC

Primary specialty

Corneal and Contact Management OptometristTaxonomy code 152WC0802X

Legal business name

PETERSON OPTOMETRIC GROUP, PLLC

Practice address

4514 Oleander Dr
Wilmington, NC 28403-5012

Phone

(910) 392-4414

Fax

(910) 392-3153

NPI assigned

Jun 24, 2016

Organization subpart

No

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

Authorized official

Name

Caroline T Peterson, ODNPI 1134520687

Title

Optometrist

Phone

(910) 392-4414

Specialties & licenses 1

Addresses

Other names 1

• Family Vision Clinic Doing business as

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Practitioners 2

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

• Caroline Therese Peterson, O.D.

  • Optometrist
  • Wilmington, NC
  • NPI 1134520687
  Medicare reassignment Care Compare group NPD Authorized official
• Boston Perkins, O.D.

  • Corneal and Contact Management Optometrist
  • Florence, SC
  • NPI 1902357791

  NC

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1466726400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1466726400000",
    "number": "1043661671",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4514 OLEANDER DR",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284035012",
            "telephone_number": "910-392-4414",
            "fax_number": "910-392-3153"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4514 OLEANDER DR",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284035012",
            "telephone_number": "910-392-4414",
            "fax_number": "910-392-3153"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETERSON OPTOMETRIC GROUP, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-06-24",
        "last_updated": "2016-06-24",
        "status": "A",
        "authorized_official_last_name": "PETERSON",
        "authorized_official_first_name": "CAROLINE",
        "authorized_official_middle_name": "T",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "910-392-4414",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152WC0802X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Family Vision Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Audry Julia Peters, LCSWA
• Joseph Peters, MSW, LCSW
• Nancy C Peters, PH.D.
• Kristian Lee Petersen, L. AC.
• Dana Peterson Dorsett, LCSW
• Caroline Therese Peterson, O.D.
• Cobern V Peterson, MD
• Gajarah Baseemah Ballard Peterson, M.D.
• Lindsay Peterson, FNP-C
• Marla Jo Peterson

• Corneal and Contact Management Optometrist in Wilmington, NC
• Providers in Wilmington, NC by specialty
• Corneal and Contact Management Optometrist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.