NPIMap

Organization Active NPI

Richard M Peters OD an Optometric Corporation

  • Optometrist
  • Wilmington, CA
National Provider Identifier
1053825570
Registry record updated Nov 20, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
4741T Issued in CA
Legal business name
RICHARD M PETERS OD AN OPTOMETRIC CORPORATION
Practice address
810 N Avalon Blvd
Wilmington, CA 90744-4502
Phone
(310) 834-5464
Fax
(310) 835-6665
NPI assigned
Nov 20, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 20, 2017

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

Authorized official

Name
Mr. Richard Michael Peters, ODNPI 1518924174
Title
Owner/President
Phone
(310) 834-5464

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 4741T CA Primary

Addresses

Primary practice location

810 N Avalon Blvd
Wilmington, CA 90744-4502

Mailing address

810 N Avalon Blvd
Wilmington, CA 90744-4502
Phone (310) 834-5464

National Provider Directory

National Provider Directory

Locations

810 N Avalon Blvd
Wilmington, CA 90744
Phone (310) 834-5464

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1511136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1511136000000",
    "number": "1053825570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "810 N AVALON BLVD",
            "city": "WILMINGTON",
            "state": "CA",
            "postal_code": "907444502",
            "telephone_number": "310-834-5464",
            "fax_number": "310-835-6665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 N AVALON BLVD",
            "city": "WILMINGTON",
            "state": "CA",
            "postal_code": "907444502",
            "telephone_number": "310-834-5464",
            "fax_number": "310-835-6665"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RICHARD M PETERS OD AN OPTOMETRIC CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-20",
        "last_updated": "2017-11-20",
        "status": "A",
        "authorized_official_last_name": "PETERS",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_middle_name": "MICHAEL",
        "authorized_official_title_or_position": "OWNER/PRESIDENT",
        "authorized_official_telephone_number": "310-834-5464",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "4741T",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2017; 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.