NPIMap

Organization Active NPI

Jay D Petersma OD PC

  • Optometrist
  • Johnston, IA
National Provider Identifier
1114279866
Registry record updated Oct 4, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
01861 Issued in IA
Legal business name
JAY D PETERSMA OD PC
Practice address
5501 NW 86TH St
Ste 500
Johnston, IA 50131-1816
Phone
(515) 270-0494
NPI assigned
Oct 4, 2012
Last updated
Oct 4, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2012

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

Authorized official

Name
Dr. Jay D Petersma, O.D.NPI 1326148933
Title
President
Phone
(515) 270-0494

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 01861 IA Primary

Addresses

Primary practice location

5501 NW 86TH St
Ste 500
Johnston, IA 50131-1816

Mailing address

5501 NW 86TH St
Ste 500
Johnston, IA 50131-1816
Phone (515) 270-0494

National Provider Directory

National Provider Directory

Locations

5501 NW 86th St
Ste 500
Johnston, IA 50131
Phone (515) 270-0494

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": "1349308800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349308800000",
    "number": "1114279866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5501 NW 86TH ST",
            "address_2": "STE 500",
            "city": "JOHNSTON",
            "state": "IA",
            "postal_code": "501311816",
            "telephone_number": "515-270-0494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5501 NW 86TH ST",
            "address_2": "STE 500",
            "city": "JOHNSTON",
            "state": "IA",
            "postal_code": "501311816",
            "telephone_number": "515-270-0494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "JAY D PETERSMA OD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-10-04",
        "last_updated": "2012-10-04",
        "status": "A",
        "authorized_official_last_name": "PETERSMA",
        "authorized_official_first_name": "JAY",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "515-270-0494",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "IA",
            "license": "01861",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Johnston, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2012; 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.