Peter Disalvo, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

CA5653T Issued in CA

Practice address

2320 Midway Dr
Santa Rosa, CA 95405-5017

Phone

(707) 526-2020

Fax

(707) 526-2032

NPI assigned

Dec 13, 2006

Sex

Male

Sole proprietor

Yes

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 CA

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

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

{
    "created_epoch": "1165968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616803200000",
    "number": "1114088796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2624 KNOLLS DR",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954058302",
            "telephone_number": "510-684-7788",
            "fax_number": "707-526-2032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2320 MIDWAY DR",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954055017",
            "telephone_number": "707-526-2020",
            "fax_number": "707-526-2032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DISALVO",
        "first_name": "PETER",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-13",
        "last_updated": "2021-03-27",
        "certification_date": "2021-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "CA5653T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0056530",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sheri Rochelle Dillon, PSY.D.
• Jessica Dimarucut, BCBA
• Dena Nicole Dimond, N.P.
• Richard C Dina, D.C.
• Nam Dinh, PHARM D
• Todd Andrew Disney, PSYD
• Divine Fijians Home Care
• Donna Divito
• Doris Dixon
• Chanh DO, D.O.

• Optometrist in Santa Rosa, CA
• Providers in Santa Rosa, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2021; 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.